title: Viral load is a significant prognostic factor for hepatitis B virus-associated hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatitis B virus (HBV) is closely linked to hepatocellular carcinoma (HCC). The objective of the current study was to identify the factors involved in the prognosis of patients with HBV-associated HCC using multivariate analysis.
  
  
  METHODS
  The current study included 74 patients with HBV-associated HCC who were admitted to Nagasaki University Hospital, Nagasaki, Japan, between 1983-1998. Of these, 13 patients underwent surgical tumor resection; 43 patients received nonsurgical treatment with transcatheter arterial embolization, percutaneous ethanol injection, or both; and 18 patients were followed without any active treatment. The significance of the patient's age; gender; history of blood transfusion; alcohol use; serum levels of alanine aminotransferase, alpha-fetoprotein, and HBV-DNA; number and size of liver tumors; clinical stage; and histologic diagnosis of HCC as prognostic factors was evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  The 3-year, 5-year, and 10-year postdiagnosis cumulative survival rates were 36%, 21%, and 17%, respectively. Multivariate analysis identified the level of serum HBV-DNA and tumor size at diagnosis as independent and significant prognostic factors (P = 0.0022 and P = 0.0106, respectively). In addition, a low level of viremia was found to be associated with longer survival (P = 0.0057) even in patients who were negative for the hepatitis B e antigen.
  
  
  CONCLUSIONS
  The results of the current study suggest that viral load is a useful prognostic marker for HBV-related HCC and that HCC patients with a less favorable course appear either to clear the virus poorly or to have a greater level of virus production.
authors.affiliation: First Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kajiya
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takeda
authors.forename: Shinnichirou
authors.initials: S
authors.lastname: Higashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hamasaki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakata
authors.forename: Katsumi
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens; D006515:Hepatitis B virus / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000150:complications; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D015996:Survival Rate; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D018937:Hepatitis C Antibodies