title: Level of hepatitis B surface antigen might serve as a new marker to predict hepatocellular carcinoma recurrence following curative resection in patients with low viral load.
abstract: To investigate the association between preoperative HBsAg (hepatitis B surface antigen) level and risk of HCC (hepatocellular carcinoma) recurrence following curative resection, we enrolled 826 HBV-related HCC patients who underwent curative resection and received long-term follow-up at the Eastern Hepatobiliary Surgery Hospital (Shanghai, China). Multivariate analyses showed that serum HBsAg ≥ 2000 S/CO, seropositive hepatitis B e antigen (HBeAg), γ-glutamyl transpeptidase > 61 U/L, prothrombin time > 13 s, multinodularity, lager tumor size, and major portal vein invasion were independently associated with a increased risk of HCC recurrence. Compared with HCC patients with HBsAg level < 2000 S/CO, HCC patients with HBsAg level ≥ 2000 S/CO had a higher prevalence of seropositive HBeAg, antiviral therapy, and cirrhosis; were younger; and had a higher levels of alanine transaminase (ALT), aspartate aminotransferase (AST), and HBV viral load. Multivariable stratified analyses showed HCC patients with HBsAg level < 2000 S/CO tended to have a lower incidence of HCC recurrence in following subgroups of patients, including for noncirrhotic (HR, 0.561; 95% CI, 0.345-0.914), HBV DNA < 2000 IU/mL (HR, 0.604; 95% CI, 0.401-0.912), ALT ≤ 41 U/L (HR, 0.643; 95% CI, 0.440-0.942), AST ≤ 37 U/L (HR, 0.672; 95% CI, 0.459-0.983), and seronegative HBeAg (HR, 0.682; 95% CI, 0.486-0.958). When we evaluated HBeAg-negative patients with HBV DNA < 2000 IU/mL, HBsAg level still determined risk of HCC recurrence (p = 0.014), but not HBV DNA (p = 0.550) and ALT (p = 0.186). These results suggest high levels of HBsAg increase risk of HCC recurrence following curative resection. HBsAg level might serve as a new marker to complement HBV DNA level in predicting HCC recurrence, especially in HBeAg-negative patients with low viral load.
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Hua-Bang
authors.initials: HB
authors.lastname: Zhou
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Qiao-Mei
authors.initials: QM
authors.lastname: Li
authors.affiliation: Department of Laboratory, First Affiliated Hospital, Bengbu Medical College Anhui, China.
authors.forename: Zheng-Rong
authors.initials: ZR
authors.lastname: Zhong
authors.affiliation: Department of Digestive Diseases, Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Hu
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Xiao-Lan
authors.initials: XL
authors.lastname: Jiang
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Hepatobiliary I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Shanghai, China.
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Hu
keywords: Hepatitis B surface antigen; hepatocellular carcinoma; recurrence