title: Does hepatitis B seroconversion affect survival outcome in patients with hepatitis B related hepatocellular carcinoma?
abstract: BACKGROUND
  Little is known about whether hepatitis B surface antigen (HBsAg) seroconversion (SC) contributes to any survival benefits for patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  All patients with hepatitis B-related HCC and HBsAg seroclearance between 1989 and 2013 were identified. Case- and control-groups were matched according to their stage of disease and mode of treatment. Baseline demographics, liver function, and overall survivals (OS) were compared between these two groups.
  
  
  RESULTS
  Thirty-nine HCC cases with HBsAg SC were identified, and 312 non-seroconversion (NSC) HCC cases were matched. Forty-eight percent of patients had curative resections, 14% were treated with ablation and 38% were for palliation. Age of patients in SC group was older than those in NSC group (P=0.026). Although there was significantly better liver function in SCvs. NSC groups in terms of bilirubin (P=0.027), albumin (P=0.003), AST (P=0.001) and ALT (P<0.001), there was no overall difference in Child-Pugh grade among the two groups. In regarding tumour pathology, SC commonly presented with solitary tumour nodule as compared to multiple nodules in NSC (P=0.027), and was also frequently associated with a normal background liver parenchyma (P<0.001). Although no survival benefit was confirmed in log-rank analysis between SC and NSC, the absolute 5-year survival of SC group was better in resection (72.2%vs. 55.3%), ablation (83.3%vs. 57.4%) and palliation (24.4%vs. 14.4%).
  
  
  CONCLUSIONS
  HCC patients with HBsAg SC are associated with a better background liver parenchyma and function, and might contribute to an improved long-term survival.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Vincent S K
authors.initials: VS
authors.lastname: Yip
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.affiliation: Department of Medical Medicine, Queen Mary Hospital, Hong Kong, China.
authors.forename: Thomas
authors.initials: T
authors.lastname: Yau
authors.affiliation: Department of Medical Medicine, Queen Mary Hospital, Hong Kong, China.
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Wing Chiu
authors.initials: WC
authors.lastname: Dai
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Siu Ho
authors.initials: SH
authors.lastname: Chok
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, Queen Mary Hospital, Hong Kong, China.
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
keywords: Hepatocellular carcinoma (HCC); hepatitis B; seroconversion (SC)