title: Hepatocellular carcinoma: high hepatitis B viral load and mortality in patients treated with transarterial chemoembolization.
abstract: OBJECTIVE
  To determine the relationship between hepatitis B virus (HBV) DNA level and the survival of patients with hepatocellular carcinoma treated by means of transarterial chemoembolization (TACE).
  
  
  METHODS
  This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. From January 2005 to March 2007, 183 patients with HBV-related hepatocellular carcinoma who underwent TACE but never received antiviral therapy were consecutively enrolled in our cohort. All patients were tested for pre-TACE serum level of HBV DNA, and overall survival was measured from date of enrollment until death from any cause. Radiologic progression was evaluated by using the modified response evaluation criteria in solid tumors by means of independent radiologic assessment.
  
  
  RESULTS
  The median overall survival was 19 months (95% confidence interval: 13.7, 24.3) and median time to progression was 4 months (95% confidence interval: 3.03, 4.97). Multivariate analysis revealed that a high pre-TACE serum level of HBV DNA (> 2000 IU/L) was an independent risk factor for reduced overall survival (P = .021; hazard ratio [HR], 1.725), high cancer progression-related mortality (P = .014; HR, 1.936), and hepatic failure-related mortality associated with cancer progression (P = .005, HR, 3.908). Pre-TACE level of HBV DNA did not significantly affect hepatic failure-related mortality that was not caused by cancer progression.
  
  
  CONCLUSIONS
  A high pre-TACE serum level of HBV DNA was associated with poor overall survival and rapid progression of hepatocellular carcinoma after TACE, and the cause of mortality was not hepatitis exacerbation but cancer progression.
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors: Su Jong
authors: SJ
authors: Yu
authors: Jeong-Hoon
authors: JH
authors: Lee
authors: Eun Sun
authors: ES
authors: Jang
authors: Eun Ju
authors: EJ
authors: Cho
authors: Min-Sun
authors: MS
authors: Kwak
authors: Jung-Hwan
authors: JH
authors: Yoon
authors: Hyo-Suk
authors: HS
authors: Lee
authors: Chung Yong
authors: CY
authors: Kim
authors: Yoon Jun
authors: YJ
authors: Kim
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy* / Q000821:virology*; D016461:Chemoembolization, Therapeutic / Q000379:methods* / Q000401:mortality; D018450:Disease Progression; D004317:Doxorubicin / Q000627:therapeutic use; D004998:Ethiodized Oil / Q000627:therapeutic use; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006509:Hepatitis B / Q000188:drug therapy / Q000401:mortality* / Q000821:virology*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin