It is a highly fatal malignancy, accounting for nearly 500 000 deaths annually, the third leading cause of cancer mortality in the world and the most important in many East Asian and sub-Saharan African countries.1,2 Potentially curative treatments for hepatocellular carcinoma (HCC) include partial hepatectomy, liver transplantation, and local ablative therapy. Among these, partial hepatectomy is a standard treatment that offers a chance of cure for patients with preserved liver function. Following curative HCC resection, 50–90%

of postoperative deaths are caused by recurrent disease. Intrahepatic recurrence, frequently the only site learn more of recurrence, occurs in 68–96% of patients.3 The concept has long been held that prevention of HBV infection and elimination or suppression of HBV should prevent or reduce development of liver cirrhosis and its complications, including HCC. The advent of highly effective HBV vaccines and several anti-HBV therapeutic agents has made this goal achievable.1,2 Vaccination reduces IWR-1 price rates of HBV infection. One of the most successful examples is the Taiwanese national infant and childhood hepatitis B vaccination program, begun in 1984, which reduced the proportion of children who were carriers of

the hepatitis B surface antigen (HBsAg) from 9.8% to 0.7% in 15 years.6 More importantly, follow-up results from the Taiwan vaccination program showed that the incidence of HCC in children 6–14 years of age significantly decreased, from 0.7 per million children between 1981 and 1986 to 0.36 per million children between 1990 and 1994.7 A meta-analysis of 12 trials (1292 interferon [IFN]-treated and 1450 untreated patients) showed that the risk of HCC was reduced by 34% (relative risk [RR]: 0.66, 95% confidence interval [CI]: 0.48–0.89; P = 0.006) O-methylated flavonoid after IFN

treatment.8 Another meta-analysis involving 11 trials also showed that IFN therapy had a beneficial effect in reducing cirrhosis and HCC.9 Using a meta-analysis involving 1267 lamivudine (LAM)-treated patients (with or without adefovir [ADV]) and 1022 untreated patients, Sung et al.8 reported that HCC was reduced by 78% (RR: 0.22, 95% CI: 0.10–0.50; P = 0.0003) on maintained LAM +/− ADV therapy. More benefit was observed in cirrhotic patients (RR: 0.17 vs 0.21) and HBeAg-positive patients (RR: 0.21 vs 0.25). The REVEAL study has shown that higher HBV viral loads are associated with higher risk of developing HCC,10 but no previous reports explored the correlation between these viral factors and late recurrence of HCC. Recently, Wu et al.11 studied 193 HBV-related HCC patients who underwent tumor resection. During the follow up of 58 months, 134 patients had HCC recurrence.