title: Hepatitis B virus DNA negativity acts as a favorable prognostic factor in hepatocellular carcinoma patients.
abstract: BACKGROUND
  This retrospective study was aimed to investigate the efficacy of prophylactic agents in hepatocellular carcinoma (HCC) patients receiving TACE and compare the difference between lamivudine and entecavir.
  
  
  METHODS
  A consecutive series of 203 HBV-related HCC patients receiving TACE were analyzed including 91 patients given prophylactic agents. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 IU/ml higher than the nadir level, hepatitis flares due to HBV reactivation and progression free survival (PFS) were the main endpoints.
  
  
  RESULTS
  Some 48 (69.6%) reached virologic response. Prophylaxis significantly reduced virologic events (8.8% vs 58.0%, p=0.000) and hepatitis flares (1.1% vs 13.4%, p=0.001). Patients presenting undetectable HBV DNA levels displayed a significantly improved PFS as compared to those who never achieved undetectable HBV DNA. Prophylaxis and e-antigen positivity were the only significant variables associated with virologic events. In addition, prophylaxis was the only independent protective factor for hepatitis flares. Liver cirrhosis, more cycles of TACE, HBV DNA negativity, a lower Cancer of the Liver Italian Program score, non-metastasis and no hepatitis flares were protective factors for PFS. Prophylactic lamivudine demonstrated similar efficacy as entecavir.
  
  
  CONCLUSIONS
  Prophylactic agents are efficacious for prevention of HBV reactivation in HCC patients receiving TACE. Achievement of undetectable HBV DNA levels displayed a significant capability in improving PFS. Moreover, persistent tumor residual lesions, positive HBV DNA and hepatitis B flares might be causes of tumor progression in these patients.
authors.affiliation: Department of Medical Oncology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China E-mail : wuxiangy@mail.sysu.edu.cn, dongmin@mail.sysu.edu.cn.
authors.forename: Xing
authors.initials: X
authors.lastname: Li
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhong
authors.forename: Zhan-Hong
authors.initials: ZH
authors.lastname: Chen
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Xing
authors.forename: Dong-Hao
authors.initials: DH
authors.lastname: Wu
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Xiao-Kun
authors.initials: XK
authors.lastname: Ma
authors.forename: Qu
authors.initials: Q
authors.lastname: Lin
authors.forename: Jing-Yun
authors.initials: JY
authors.lastname: Wen
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Wang
authors.forename: Dan-Yun
authors.initials: DY
authors.lastname: Ruan
authors.forename: Ze-Xiao
authors.initials: ZX
authors.lastname: Lin
authors.forename: Xiang-Yuan
authors.initials: XY
authors.lastname: Wu
authors.forename: Min
authors.initials: M
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D016461:Chemoembolization, Therapeutic; D002648:Child; D004279:DNA, Viral / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C413685:entecavir; D006147:Guanine