title: The impact of hepatitis B viral load on recurrence after complete necrosis in patients with hepatocellular carcinoma who receive transarterial chemolipiodolization: implications for viral suppression to reduce the risk of cancer recurrence.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) has a high tendency for recurrence after radical treatment. Apart from tumor and liver function parameters, little is known about the role of hepatitis B virus (HBV) factors in the recurrence of HCC. The objective of this study was to identify the potential relation between viral load and HCC recurrence in patients undergoing transarterial chemolipiodolization.
  
  
  METHODS
  This was a cohort study of 62 consecutive patients who had HBV-related HCC and achieved complete necrosis with transarterial chemolipiodolization. Risk factors, including viral load for posttreatment recurrence, were analyzed.
  
  
  RESULTS
  Overall, 32 of 62 patients (51.6%) developed a recurrence during the study period (7.2-37.5 months). Multivariate analysis established Child-Pugh Class B (P = .014), multiple tumors (P = .013), and high viral load (HBV DNA levels >10(5) copies/mL) at complete necrosis (P = .001) as independent risk factors for recurrence. On both univariate and multivariate analyses, high viral load at the time of complete necrosis was identified as the strongest factor for recurrence; moreover, its statistically significant effects still were observed even when conducting the analyses separately for both local recurrence (P = .018) and distant recurrence (P = .009).
  
  
  CONCLUSIONS
  Among individuals who underwent transarterial chemolipiodolization, high HBV viral load at complete necrosis was among the most important risk factors for posttreatment recurrence, irrespective of the locational pattern of recurrence. The current findings underscored the need for future work that tests the applicability of antiviral therapy to reduce the risk of HCC recurrence in this setting.
authors.affiliation: Department of Internal Medicine, College of Medicine, World Health Organization Collaborating Center on Viral Hepatitis, the Catholic University of Korea, Seoul, Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Woo
authors.forename: U Im
authors.initials: UI
authors.lastname: Chang
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Soon Woo
authors.initials: SW
authors.lastname: Nam
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Yang
authors.forename: Chang Don
authors.initials: CD
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy / Q000821:virology*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006499:Hepatic Artery; D006509:Hepatitis B / Q000628:therapy / Q000821:virology*; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000628:therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012307:Risk Factors; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D007459:Iodized Oil