title: Hepatitis B virus infection predicts extrahepatic metastasis after hepatic resection in patients with large hepatocellular carcinoma.
abstract: BACKGROUND
  Although extrahepatic metastasis occurs rarely after hepatic resection for hepatocellular carcinoma (HCC), the prognosis of these patients is extremely poor. Predictors of extrahepatic metastasis have not been fully investigated.
  
  
  METHODS
  To identify predictors of extrahepatic metastasis after resection, we retrospectively investigated 77 patients with HCC tumors > 50 mm in diameter who underwent hepatic resection. We investigated correlations between postoperative extrahepatic metastasis and clinicopathologic factors as well as extrahepatic metastasis-free survival rate by log rank test and predictors of extrahepatic metastasis by univariate and multivariate logistic regression models.
  
  
  RESULTS
  Hepatitis B surface antigen (HBs-Ag) was found in 25 (32.5%) of 77 patients, and extrahepatic metastasis occurred in 26 (33.8%). Patients with extrahepatic metastasis showed better liver function and a high occurrence of HBs-Ag positivity than those without. The 5-year extrahepatic metastasis-free survival rate was worse in patients with HBs-Ag positivity, larger tumors (> or = 70 mm), higher alfa-fetoprotein level (> or = 300 ng/mL), and lower indocyanine green retention rate at 15 minutes (ICGR15) (< 15%) than in those without. By univariate logistic regression analysis, HBs-Ag positivity, larger HCC tumor (> or = 70 mm), lower ICGR15 (< 15%), and lower preoperative lymphocyte count (< 1000/mm3) were predictors of extrahepatic metastasis (P < .1). By multivariate analysis, HBs-Ag positivity was an independent predictor of postoperative extrahepatic metastasis (P = .04).
  
  
  CONCLUSIONS
  In patients positive for HBs-Ag, radiologic examination of extrahepatic organs should be performed as a part of the postoperative surveillance. Hepatitis B virus infection may promote establishment of extrahepatic metastasis.
authors.affiliation: Department of Surgery, National Hospital Organization Miyazaki Hospital, Miyazaki, 889-1301, Japan. sasakia@med.oita-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sasaki
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kai
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Endo
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Uchida
authors.forename: Kohei
authors.initials: K
authors.lastname: Shibata
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohta
authors.forename: Seigo
authors.initials: S
authors.lastname: Kitano
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000821:virology*; D005260:Female; D006498:Hepatectomy; D006509:Hepatitis B / Q000175:diagnosis*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins