Transarterial chemo-lipiodolization can reactivate hepatitis B virus replication in patients with hepatocellular carcinoma.
OBJECTIVE
Reactivation of hepatitis B virus (HBV) replication is a well-known complication in cancer patients receiving chemotherapy. The aims of this study were to determine the incidence of HBV reactivation in hepatocellular carcinoma (HCC) patients undergoing transarterial chemo-lipiodolization, and to clarify factors contributing to HBV reactivation.


METHODS
From April 2001 to September 2002, 146 HBsAg positive patients newly diagnosed as HCC were enrolled in the study. Among these, 83 patients underwent transarterial chemo-lipiodolization using epirubicin and/or cisplatin, and 63 received other treatments.


RESULTS
In total, HBV reactivation occurred in 30 (20.5%) patients (28 with chemo-lipiodolization and 2 with other treatments), and of the 30 patients, 19 (13.0%) (18 with chemo-lipiodolization and 1 with other treatments) developed hepatitis. Chemo-lipiodolization was significantly correlated with a higher incidence of hepatitis attributed to HBV reactivation than other treatments (21.7% vs. 1.6%, P<0.001), irrespective of HBeAg or HBV DNA. Among 83 patients undergoing chemo-lipiodolization, HBV reactivation occurred in 28 (33.7%) patients, and HBeAg seropositivity was the only independent predictor of HBV reactivation (P=0.013). Three (10.7%) of them died of hepatic decompensation resulting from HBV reactivation.


CONCLUSIONS
Transarterial chemo-lipiodolization can reactivate HBV, and HBeAg-positive HCC patients receiving chemo-lipiodolization should be closely monitored for HBV reactivation.
Jang
Jeong Won
JW
Division of Hepatology, Department of Internal Medicine, College of Medicine, WHO collaborating Center on Viral Hepatitis, Catholic University of Korea, #505 Banpodong, Seocho-ku, 137-040 Seoul, South Korea.
Choi
Jong Young
JY
Bae
Si Hyun
SH
Kim
Chang Wook
CW
Yoon
Seung Kew
SK
Cho
Se Hyun
SH
Yang
Jin Mo
JM
Ahn
Byung Min
BM
Lee
Chang Don
CD
Lee
Young Sok
YS
Chung
Kyu Won
KW
Sun
Hee Sik
HS
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000150:complications / Q000209:etiology* / Q000821:virology; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014775:Virus Activation / Q000187:drug effects
D000970:Antineoplastic Agents; D015251:Epirubicin; D007459:Iodized Oil; D002945:Cisplatin