title: Risk factors for early and late recurrence in hepatitis B-related hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) levels correlate with the development of hepatocellular carcinoma (HCC), but the role of viral load in HCC recurrence after tumor resection remains unclear. Herein we aimed to investigate the role of viral load in HCC recurrence following tumor resection.
  
  
  METHODS
  From 1990 to 2002, 193 HBV-related HCC patients who underwent tumor resection in Taipei Veterans General Hospital were enrolled. Serum HBV DNA level and mutations were analyzed for association with early and late recurrence, together with other clinical variables.
  
  
  RESULTS
  During a follow-up of 58.2+/-44 months, 134 patients had HCC recurrence. Multivariate analysis showed that multinodularity (Hazard ratio [HR], 95% confidence interval [CI]; 2.232, 1.021-4.878), macroscopic venous invasion (4.693, 1.645-13.391), AFP >20 ng/ml (3.891, 1.795-8.475), and cut margin <or= 1cm (3.333, 1.487-7.470) were correlated with early recurrence (within two years of operation) of HCC. In addition, multivariate analysis determined that Ishak hepatic inflammatory activity >6 (4.658, 1.970-11.017), multinodularity (3.266, 1.417-7.526), ICG-15 >10% (2.487, 1.095-5.650) and HBV DNA level >10(6) copies/ml (2.548, 1.040-6.240) were significantly associated with late recurrence (>two years after resection). Patients with high viral loads tended to have higher Ishak inflammatory (7.00+/-3.07 vs. 5.33+/-2.96, p=0.001) and fibrosis scores (4.17+/-2.01 vs. 3.20+/-2.41, p=0.007) than those with lower loads.
  
  
  CONCLUSIONS
  Tumor factors were associated with early HCC recurrence while high viral loads and hepatic inflammatory activity were associated with late recurrence. Pre- and post-operative antiviral and anti-inflammatory therapies may be crucial in reducing late recurrence.
authors.affiliation: Department of Medical Research and Education, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. jcwu@vghtpe.gov.tw
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Gar-Yang
authors.initials: GY
authors.lastname: Chau
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Chung-Ru
authors.initials: CR
authors.lastname: Lai
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: I-Jane
authors.initials: IJ
authors.lastname: Sheen
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000601:surgery / Q000821:virology; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000601:surgery / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000517:prevention & control / Q000821:virology; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D019562:Viral Load
chemical_list: D004279:DNA, Viral