The preoperative positivity for serum hepatitis B e antigen did not affect overall survival after curative resection of hepatitis B virus-related hepatocellular carcinoma.
OBJECTIVE
Previous studies have reported different risk factors for early and late intrahepatic recurrence after resection of hepatocellular carcinoma (HCC). However, the prognostic significance of the risk factors for early and late recurrence has not been clarified.


METHODS
A total of 190 Hepatitis B surface antigen-positive patients who received curative resection for HCC were reviewed. We investigated prognostic factors for disease-free and overall survival after resection, and further analyzed the relationship between significant prognostic factors and risk factors for early (<or=14 months) and late (>14 months) intrahepatic recurrence.


RESULTS
The 5-year disease-free and overall survival rates were 43.9% and 71.5%, respectively. In multivariate analysis, adverse prognostic factors for disease-free survival were presence of serum HBeAg, perioperative transfusion, and the presence of portal vein invasion (PVI) and/or intrahepatic metastasis (IM). Multivariate analysis revealed that overall survival was associated with ICG R15, serum albumin, Edmondson-Steiner grade, and the presence of PVI and/or IM. Independent risk factors for early intrahepatic recurrence were perioperative transfusion and PVI and/or IM, whereas positivity for HBeAg was the only risk factor for late recurrence. In addition, post-recurrence survival in patients with late intrahepatic recurrence was completely comparable to that of patients who never experienced recurrence.


CONCLUSIONS
The presence of serum HBeAg, the risk factor for late intrahepatic recurrence did not affect overall survival after resection because late recurrence was relatively well controlled by current available treatments. To further improve long-term surgical outcomes, effective treatment and preventive methods for early intrahepatic recurrence should be investigated.
Choi
Gi Hong
GH
Department of Surgery, Yonsei University Health System, Seoul, Korea.
Kim
Dong Hyun
DH
Choi
Sae Byeol
SB
Kang
Chang Moo
CM
Kim
Kyung Sik
KS
Choi
Jin Sub
JS
Lee
Woo Jung
WJ
Han
Kwang Hyub
KH
Chon
Chae Yoon
CY
Kim
Byong Ro
BR
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000601:surgery; D006513:Hepatitis B e Antigens / Q000097:blood*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein / Q000473:pathology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006513:Hepatitis B e Antigens