title: Risk Factors and Post-Resection Independent Predictive Score for the Recurrence of Hepatitis B-Related Hepatocellular Carcinoma.
abstract: BACKGROUND
  Independent risk factors associated with hepatitis B (HBV)-related hepatocellular carcinoma (HCC) after resection remains unknown. An accurate risk score for HCC recurrence is lacking.
  
  
  METHODS
  We prospectively followed up 200 patients who underwent liver resection for HBV-related HCC for at least 2 years. Demographic, biochemical, tumor, virological and anti-viral treatment factors were analyzed to identify independent risk factors associated with recurrence after resection and a risk score for HCC recurrence formulated.
  
  
  RESULTS
  Two hundred patients (80% male) who underwent liver resection for HBV-related HCC were recruited. The median time of recurrence was 184 weeks (IQR 52-207 weeks) for the entire cohort and 100 patients (50%) developed HCC recurrence. Stepwise Cox regression analysis identified that one-month post resection HBV DNA >20,000 IU/mL (p = 0.019; relative risk (RR) 1.67; 95% confidence interval (C.I.): 1.09-2.57), the presence of lymphovascular permeation (p<0.001; RR 2.69; 95% C.I.: 1.75-4.12), microsatellite lesions (p<0.001; RR 2.86; 95% C.I.: 1.82-4.51), and AFP >100ng/mL before resection (p = 0.021; RR 1.63; 95% C.I.: 1.08-2.47) were independently associated with HCC recurrence. Antiviral treatment before resection (p = 0.024; RR 0.1; 95% C.I.: 0.01-0.74) was independently associated with reduced risk of HCC recurrence. A post-resection independent predictive score (PRIPS) was derived and validated with sensitivity of 75.3% and 60.6% and specificity of 55.7% and 79.2%, to predict the 1- and 3-year risks for the HCC recurrence respectively with the hazard ratio of 2.71 (95% C.I.: 2.12-3.48; p<0.001). The AUC for the 1- and 3-year prediction were 0.675 (95% C.I.: 0.6-0.78) and 0.746 (95% C.I.: 0.69-0.82) respectively.
  
  
  CONCLUSIONS
  Several tumor, virological and biochemical factors were associated with a higher cumulative risk of HCC recurrence after resection. PRIPS was derived for more accurate risk assessment. Regardless of the HBV DNA level, antiviral treatment should be given to patients before resection to reduce the risk of recurrence.
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Ivan Fan-Ngai
authors.initials: IF
authors.lastname: Hung
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.|State Key Laboratory for Liver Research, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Danny Ka-Ho
authors.initials: DK
authors.lastname: Wong
authors.affiliation: Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Ronnie Tung-Ping
authors.initials: RT
authors.lastname: Poon
authors.affiliation: School of Nursing Studies, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Daniel Yee-Tak
authors.initials: DY
authors.lastname: Fong
authors.affiliation: Quality & Safety Division, New Territories West Cluster, Hospital Authority, Hong Kong, China.
authors.forename: Ada Hang-Wai
authors.initials: AH
authors.lastname: Chui
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Wai-Kay
authors.initials: WK
authors.lastname: Seto
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: James Yan-Yue
authors.initials: JY
authors.lastname: Fung
authors.affiliation: Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Albert Chi-Yan
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.|State Key Laboratory for Liver Research, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: John Chi-Hang
authors.initials: JC
authors.lastname: Yuen
authors.affiliation: Department of Clinical Oncology, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Randal
authors.initials: R
authors.lastname: Tiu
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Olivia
authors.initials: O
authors.lastname: Choi
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.|State Key Laboratory for Liver Research, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.|State Key Laboratory for Liver Research, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral