title: Hepatitis B viral load predicts survival of HCC patients undergoing systemic chemotherapy.
abstract: HCC is a common cause of morbidity and mortality. For patients who are not candidates for curative surgery, systemic chemotherapy is one of the standard treatments. In parts of China and the Far East, over 80% of HCC patients have chronic HBV infection. In this study, we aimed to assess the relationship between pre-chemotherapy HBV viral load and the survival of HCC patients. HBV infection status was determined prior to chemotherapy in 188 patients, 170 of whom had evidence of HBV chronic infection/exposure (160 hepatitis B surface antigen [HBsAg]-positive, 10 HBsAg-negative/hepatitis B core antibody-positive). Of these, 125 had pretreatment HBV DNA levels determined via real-time PCR. Virological data were analyzed using conventional clinical variables to identify factors that influenced survival. Multivariate analysis revealed that high total bilirubin (P = 0.0016; hazard ratio = 1.040 per 1 muM increase; 95% CI 1.015-1.065), HCV infection (P = 0.0095; hazard ratio = 6.955; 95% CI 1.606-30.129), and high HBV DNA level (P = 0.0217; hazard ratio = 1.650; 95% CI 1.076-2.531) affected survival significantly. Exploratory analysis revealed that high levels of pretreatment HBV DNA had a significantly higher incidence of severe hepatitis during chemotherapy.
  
  
  CONCLUSIONS
  For HCC patients with HBV chronic infection/exposure, a high viral load prior to treatment is an adverse factor for survival and may be associated with a higher incidence of severe hepatitis during chemotherapy. Future strategies to improve the prognosis of HCC patients undergoing chemotherapy should consider supportive therapy that incorporates antiviral therapies to reduce HBV viral load.
authors.affiliation: Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. winnie.yeo@cuhk.edu.hk
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.forename: Frankie K F
authors.initials: FK
authors.lastname: Mo
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.forename: Nancy W Y
authors.initials: NW
authors.lastname: Leung
authors.forename: Pun
authors.initials: P
authors.lastname: Hui
authors.forename: Wai-Yip
authors.initials: WY
authors.lastname: Lam
authors.forename: Tony S K
authors.initials: TS
authors.lastname: Mok
authors.forename: Kowk C
authors.initials: KC
authors.lastname: Lam
authors.forename: Wing M
authors.initials: WM
authors.lastname: Ho
authors.forename: Jane
authors.initials: J
authors.lastname: Koh
authors.forename: Julian W
authors.initials: JW
authors.lastname: Tang
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Chan
authors.forename: Paul K S
authors.initials: PK
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000494:pharmacology; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000494:pharmacology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins; D016019:Survival Analysis; D019562:Viral Load
chemical_list: D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil