title: High levels of hepatitis B surface antigen are associated with poorer survival and early recurrence of hepatocellular carcinoma in patients with low hepatitis B viral loads.
abstract: OBJECTIVE
  Recurrence is a disastrous outcome in patients with hepatitis-related hepatocellular carcinoma (HCC) who have undergone curative resection, and little is known about whether high levels of hepatitis B surface antigen (HBsAg) increase the risk of HCC recurrence.
  
  
  METHODS
  This retrospective study included 1,360 HBsAg-positive postoperative HCC patients with hepatitis B viral (HBV) DNA levels < 2000 IU/mL, including 298 patients in a training cohort and 1,062 patients in a validation cohort. The prognostic value of the HBsAg level was evaluated using Cox regression and Kaplan-Meier analyses.
  
  
  RESULTS
  We demonstrated that 1,000 IU/mL, but not 10 or 100 IU/mL, was a meaningful cutoff level for significantly discriminating these patients into an HBsAg(Low) group and an HBsAg(High) group based on correlations between the HBsAg level and liver cirrhosis (p = 0.028), tumor size (p = 0.039), and hepatitis B e antigen level (p < 0.001). The postoperative 1-, 3-, and 5-year overall survival (OS) rates of HCC patients in the HBsAg(Low) group were significantly higher than those of HCC patients in the HBsAg(High) group. Accordingly, the 5-year recurrence-free survival (RFS) rates of patients in the HBsAg(Low) group were markedly higher than those of HCC patients in the HBsAg(High) group. The HBsAg level was a prognostic indicator for OS (p = 0.014) and RFS (p = 0.01).
  
  
  CONCLUSIONS
  HBsAg level is correlated with more aggressive tumor behavior and serves as a prognostic indicator in patients with surgically resected HCC with low HBV load.
authors.affiliation: Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
authors.forename: Wei-Ren
authors.initials: WR
authors.lastname: Liu
authors.forename: Meng-Xin
authors.initials: MX
authors.lastname: Tian
authors.forename: Lei
authors.initials: L
authors.lastname: Jin
authors.forename: Liu-Xiao
authors.initials: LX
authors.lastname: Yang
authors.forename: Zhen-Bin
authors.initials: ZB
authors.lastname: Ding
authors.forename: Ying-Hao
authors.initials: YH
authors.lastname: Shen
authors.forename: Yuan-Fei
authors.initials: YF
authors.lastname: Peng
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
authors.forename: Zhi
authors.initials: Z
authors.lastname: Dai
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Ying-Hong
authors.initials: YH
authors.lastname: Shi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000378:metabolism*; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications / Q000378:metabolism / Q000401:mortality* / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019562:Viral Load
chemical_list: D006514:Hepatitis B Surface Antigens