title: Postoperative hepatitis B virus reactivation in hepatitis B virus-related hepatocellular carcinoma patients with hepatitis B virus DNA levels <500 copies/mL.
abstract: BACKGROUND
  Patients with hepatocellular carcinoma have the risk of postoperative hepatitis B virus (HBV) reactivation (PHR). Antiviral therapy was given to patients with detectable HBV DNA levels but not to patients with undetectable HBV DNA levels.
  
  
  METHODS
  In this retrospective study, 258 patients were enrolled (HBV DNA levels <500 copies/mL group, n=159, and HBV DNA levels >500 copies/mL group, n=99).
  
  
  RESULTS
  A total of 50 patients (19.4%) had PHR. The following significant factors related to PHR were found: without antiviral therapy (hazard ratio [HR] =0.17, 95% confidence interval [CI] 0.031-0.911), hepatitis B e antigen positivity (HR =5.20, 95% CI 1.931-14.007), hepatitis B core antigen S1 positivity (HR =2.54, 95% CI 1.116-5.762), preoperative HBV DNA levels ≥500 copies/mL (HR =1.28, 95% CI 1.085-2.884), hepatic inflow occlusion (HR =3.60, 95% CI 1.402-9.277), moderate liver cirrhosis or more (HR =2.26, 95% CI 1.001-5.121), and blood transfusion (HR =2.89, 95% CI 0.836-10.041). Recurrence-free survival time was significantly shorter in patients with PHR (23.06±2.46 months) than in patients without PHR (29.30±1.27 months).
  
  
  CONCLUSIONS
  Antiviral therapy could efficiently decrease the incidence of PHR. Patients with HBV DNA levels <500 copies/mL still have the risk of PHR. PHR remained as a prognostic risk factor for hepatocellular carcinoma recurrence and recurrence-free survival.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai.
authors.forename: Zhi-Bo
authors.initials: ZB
authors.lastname: Xie
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; Department of Hepatobiliary Surgery, Affiliated Minzu Hospital of Guangxi Medical University.
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Wang
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Fu
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, People's Republic of China.
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Zhong
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Xia-Wei
authors.initials: XW
authors.lastname: Yang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, People's Republic of China.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
keywords: HBV DNA levels; hepatectomy; hepatitis B virus; hepatocellular carcinoma; postoperative reactivation