Hepatitis B virus reactivation in hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization therapy.
OBJECTIVE
The effect of transcatheter arterial chemoembolization (TACE) therapy on hepatitis B virus (HBV) reactivation in hepatocellular carcinoma (HCC) patients with prior resolved hepatitis B is not fully understood.


METHODS
From January 2006 to December 2010, 43 hepatitis B surface antigen (HBsAg)-negative/anti-hepatitis B core antigen (HBc) positive patients with newly diagnosed unresectable HCC were enrolled in the study. All underwent TACE therapy.


RESULTS
Four patients (9.3%) developed HBV reactivation with mild/moderate hepatitis. The median number of TACE cycles received was 3.5 (range 3-4 cycles). The median time interval between the occurrence of HBV reactivation and the completion of TACE therapy was 3 months (range 1-5 months) and their median HBV DNA level was 1.58 × 10(4) IU/mL (range, 1.65 × 10(3) -6.42 × 10(4)  IU/mL). After the introduction of lamivudine at the occurrence of HBV reactivation, all had resolution of hepatitis. An exploratory analysis indicated that significant predictors of HBV reactivation included increased serum total bilirubin coexisting with cirrhosis and the total number of cycles of TACE received.


CONCLUSIONS
The administration of TACE therapy may increase the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients diagnosed with unresectable HCC. Further studies are warranted to explore the optimal management of HBV reactivation in patients with prior resolved hepatitis B.
Department of Medical Oncology, Zhongshan Hospital of Sun Yat-sen University, Zhongshan People's City Hospital, Zhongshan 528403, China.
Jie-Wen
JW
Peng
Gui-Nan
GN
Lin
Jian-Jun
JJ
Xiao
Xiao-Mei
XM
Jiang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000276:immunology / Q000628:therapy* / Q000821:virology*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage / Q000031:analogs & derivatives; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D012189:Retrospective Studies; D014775:Virus Activation / Q000187:drug effects
D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; C493949:hydroxycamptothecin polybutylcyanoacrylate; D016685:Mitomycin; D004998:Ethiodized Oil; D004659:Enbucrilate