title: Quantitative HBV DNA and AST are strong  predictors for survival after HCC detection in  chronic HBV patients.
abstract: Hepatitis B virus infection (HBV) is an important co-factor in the development of hepatocellular carcinoma (HCC). We studied whether quantitative HBV DNA at time of HCC detection influences survival of HCC patients. All diagnosed HCC cases between 2000 and 2008 at our university-based reference centre were analysed to determine the influence of hepatitis B viral load on overall survival. Clinical and virological findings were evaluated in univariate and multivariate analyses, survival rates were assessed for HCC patients with a high viral load (HBV DNA ≥10(5) copies/ml) and low viral load (HBV DNA <10(5) copies/ml). HCC was diagnosed in 597 patients, including 98 patients with HBV. The group of 37 patients (38%) who had a high viral load contained more HBeAg-positive patients, had lower serum albumin levels and higher serum aspartate aminotransferase (AST ) and alanine aminotransferase (ALT ) levels. The one- and five-year survival rates of HCC patients with a high viral load were 58% and 11% and for HCC patients with a low viral load 70% and 35%, respectively. In multivariate analysis a higher AST level and higher viral load were significantly associated with shorter overall survival (HR=2.30; p=0.018, HR=1.22; p=0.015, respectively). HBeAg positivity, low albumin level or high AST or ALT levels in HCC patients are associated with a higher HBV DNA . HBV DNA level at detection is associated with overall survival of HCC patients. These findings support the concept that after HCC detection adequate suppression of HBV DNA by nucleoside analogue therapy may improve survival.
authors.affiliation: Department of Hepatobiliary and Transplantation Surgery, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
authors.forename: C D M
authors.initials: CD
authors.lastname: Witjes
authors.forename: J N M
authors.initials: JN
authors.lastname: IJzermans
authors.forename: A A
authors.initials: AA
authors.lastname: van der Eijk
authors.forename: B E
authors.initials: BE
authors.lastname: Hansen
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
authors.forename: R A
authors.initials: RA
authors.lastname: de Man
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000201:enzymology / Q000401:mortality* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000201:enzymology*; D006801:Humans; D008113:Liver Neoplasms / Q000201:enzymology / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase