Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels.
OBJECTIVE
In patients with low viral loads, high levels of hepatitis B surface antigen (HBsAg) have been shown to predict development of hepatocellular carcinoma (HCC). Whether high levels of HBsAg increase the risk for HCC recurrence after hepatic resection remains unknown.


OBJECTIVE
To investigate the association between levels of HBsAg and the risk for tumor recurrence after curative resection in HCC patients with low levels of hepatitis B virus (HBV) DNA.


METHODS
We performed a retrospective analysis of the clinical data of 1062 patients with low HBV DNA levels (<200 IU/mL) who underwent partial hepatectomy for HCC. In particular, we investigated the association between levels of HBsAg and recurrence of HCC.


METHODS
Partial hepatectomy for HCC.


METHODS
The risk for first tumor recurrence between patients with high and low HBsAg levels. We calculated cumulative incidences and hazard ratios after adjusting for competing mortality.


RESULTS
The risk for tumor recurrence increased with HBsAg levels of 1000 IU/mL or greater. When we compared the groups with low (<1000 IU/mL) and high (≥1000 IU/mL) HBsAg levels, the 5-year disease-free survival rate (46.1% vs 34.1% [P = .002]) and the overall survival rate (57.5% vs 48.8% [P = .004]) were better in the group with low HBsAg levels. On multivariate analysis, hepatitis B e antigen seropositivity, HBsAg level of 1000 IU/mL or greater, tumor size of greater than 5 cm, blood transfusion, surgical margin of less than 1.0 cm, the presence of satellite nodules, and the presence of portal vein tumor thrombus were independent risk factors for HCC recurrence. When compared with hepatitis B e antigen status, HBsAg level better predicted recurrence of HCC.


CONCLUSIONS
A preoperative HBsAg level of 1000 IU/mL or greater is an independent risk factor for HCC recurrence in patients with low HBV DNA levels.
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Gang
G
Huang
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China2Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
Wan Yee
WY
Lau
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Wei-ping
WP
Zhou
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Feng
F
Shen
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Ze-ya
ZY
Pan
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Sheng-xian
SX
Yuan
Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Meng-chao
MC
Wu
D014408:Biomarkers, Tumor / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D003952:Diagnostic Imaging; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000821:virology; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load
D014408:Biomarkers, Tumor; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens