title: Sustained low hepatitis B viral load predicts good outcome after curative resection in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Little is known about the role of hepatitis B virus (HBV) factors in the long-term prognosis of hepatocellular carcinoma (HCC) after resection. The objective of the present study was to identify the changing patterns of HBV levels and its effect on outcome after resection.
  
  
  METHODS
  This study recruited 188 patients with HBV-related HCC who underwent curative resection. Among the 188 patients, 115 were alive without recurrence at 12 months, and had serial measurements of viral levels.
  
  
  RESULTS
  The mean age was 53 years and the mean follow-up period was 48.5 months. With multivariate analysis, tumor size > 5 cm (P = 0.047), Child-Pugh class B (P = 0.017), vascular invasion (P = 0.028), and HBV DNA > 10(4) copies/mL at the time of resection (P = 0.003) were independently predictive of HCC recurrence for the entire population. For the 115 patients with serial measurements of viral levels, tumor size > 5 cm, HBV DNA > 10(4) copies/mL at resection, and the absence of sustained HBV DNA level < 10(4) copies/mL, the presence of cirrhosis, and elevated aminotransferase levels (> 40 IU/L) were marginally or significantly associated with HCC recurrence and overall survival. However, on multivariate analysis, sustained HBV DNA level < 10(4) copies/mL was the only factor for both low recurrence (P = 0.002; odds ratio [OR] 3.13; 95% confidence interval [CI] 1.55-6.35) and longer survival (P = 0.002; OR 3.76; 95% CI 1.61-8.78).
  
  
  CONCLUSIONS
  A high HBV replication state is among the most important predictors of adverse outcome after resection of HBV-related HCC. The sustained suppression of HBV below 10(4) copies/mL is a strong protective factor for long-term recurrence-free and overall survival.
authors.affiliation: Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ho Jung
authors.initials: HJ
authors.lastname: An
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: June Yeol
authors.initials: JY
authors.lastname: Han
authors.forename: Keun Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jung
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery* / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D018572:Disease-Free Survival; D006498:Hepatectomy; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006515:Hepatitis B virus / Q000235:genetics* / Q000254:growth & development; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral