title: Impact of postoperative hepatitis B virus reactivation in hepatocellular carcinoma patients who formerly had naturally suppressed virus.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) replication detected before the resection of hepatocellular carcinoma (HCC) is to be controlled by antiviral agents. However, management strategy for patients with preoperatively undetectable HBV DNA without antiviral therapy is not clearly delineated. This study investigated viral reactivation after the liver resection in non-replicating HBV DNA-related HCC patients and its impact on the surgical outcome.
  
  
  METHODS
  From 198 patients that underwent liver resection due to HBV-related HCC, 101 patients who had serially checked serum HBV DNA were analyzed.
  
  
  RESULTS
  From 101 patients, 33 patients had baseline undetectable HBV DNA. Eleven patients (11/33, 33.3%) had viral replication after the liver resection. The postoperative viral reactivation (HR: 2.144; 95% CI: 1.122-4.097; P = 0.021), along with the existence of satellite nodules (HR: 3.034; 95% CI: 1.1.376-6.689; P = 0.006), existence of microvascular invasion (HR: 2.479; 95% CI: 1.303-4.718; P = 0.006), and HBeAg positivity (HR: 2.059; 95% CI: 1.155-3.670; P = 0.014) predicted recurrence after the surgery. Quantification of intrahepatic total and covalently closed circular DNA (cccDNA) was done in 14 patients whose baseline serum HBV DNA was undetectable without the use of antiviral agent. Amount of intrahepatic cccDNA expressed as copies/hepatocyte in patients with postoperative viral reactivation showed significantly higher than those in patients with sustained negative serum HBV DNA (P = 0.010).
  
  
  CONCLUSIONS
  This study shows that naturally suppressed preoperative HBV without application of antiviral agent does not ensure undetectable serum HBV after the surgery, and postoperative viral reactivation might be associated with HCC recurrence.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Liver Cirrhosis Clinical Trial Center, Seoul, Republic of Korea.
authors: Jung Il
authors: JI
authors: Lee
authors: Ja Kyung
authors: JK
authors: Kim
authors: Hye Young
authors: HY
authors: Chang
authors: Jin-Woo
authors: JW
authors: Lee
authors: Joon Mee
authors: JM
authors: Kim
authors: Hyun Jung
authors: HJ
authors: Chung
authors: Young Soo
authors: YS
authors: Kim
authors: Kwan Sik
authors: KS
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000821:virology*; D004270:DNA, Circular / Q000378:metabolism; D004279:DNA, Viral / Q000097:blood / Q000378:metabolism; D005260:Female; D006498:Hepatectomy; D006515:Hepatitis B virus / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000378:metabolism; D008113:Liver Neoplasms / Q000601:surgery / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000821:virology; D011184:Postoperative Period; D014779:Virus Replication
chemical_list: D004270:DNA, Circular; D004279:DNA, Viral
keywords: covalently closed circular DNA; hepatitis B virus; hepatocellular carcinoma; prognosis; virus replication