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.
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.
Jang
Jeong Won
JW
Department of Internal Medicine, College of Medicine, World Health Organization Collaborating Center on Viral Hepatitis, the Catholic University of Korea, Seoul, Korea.
Choi
Jong Young
JY
Bae
Si Hyun
SH
Yoon
Seung Kew
SK
Woo
Hyun Young
HY
Chang
U Im
UI
Kim
Chang Wook
CW
Nam
Soon Woo
SW
Cho
Se Hyun
SH
Yang
Jin Mo
JM
Lee
Chang Don
CD
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
D004279:DNA, Viral; D007459:Iodized Oil