title: High hepatitis B viral load predicts recurrence of small hepatocellular carcinoma after curative resection.
abstract: A retrospective cohort study was conducted to identify risk factors for recurrence of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative resection. A total of 317 patients who had received curative resection of pathologically proven small HCC (< or = 3 cm in diameter) were analyzed to ascertain the factors affecting recurrence. The median follow-up period was 33.7 months. Cumulative recurrence rates at 1, 3, and 5 years after resection were 23.5%, 49.5%, and 65.5%, respectively. Male sex, alpha-fetoprotein (AFP) > or = 400 ng/mL, HBV DNA level > or = 4 log(10) copies/mL, prolonged prothrombin time, tumor size > or = 2 cm, microvascular invasion, absence of capsular formation, moderate/poor tumor differentiation, and absence of postoperative interferon-alpha (IFN-alpha) treatment were associated with increased cumulative risk of HCC recurrence. By multivariate analysis, HBV DNA level > or = 4 log(10) copies/mL (P < 0.001, hazard ratio (HR) 2.110), AFP > or = 400 ng/mL (P = 0.011, HR 1.574), microvascular invasion (P < 0.001, HR 1.767), and postoperative IFN-alpha treatment (P = 0.022, HR 0.562) remained to be independently associated with HCC recurrence. Those contributing to late recurrence (>2 years) were older age and HBV DNA level > or = 4 log(10) copies/mL. Patients with persistent HBV DNA level > or = 4 log(10) copies/mL at resection and follow-up had the highest recurrence risk (P < 0.001, HR 4.129). HBV DNA level > or = 4 log(10) copies/mL at the time of resection was the most important risk factor for recurrence. Postoperative IFN-alpha treatment significantly decreased the recurrence risk after resection.
authors.affiliation: Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai 200032, China.
authors.forename: Li-Shuai
authors.initials: LS
authors.lastname: Qu
authors.forename: Fei
authors.initials: F
authors.lastname: Jin
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Huang
authors.forename: Xi-Zhong
authors.initials: XZ
authors.lastname: Shen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D004279:DNA, Viral; D016898:Interferon-alpha; D000509:alpha-Fetoproteins