Sustained low hepatitis B viral load predicts good outcome after curative resection in patients with hepatocellular carcinoma

Authors

  • Ho Jung An,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jeong Won Jang,

    Corresponding author
    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Si Hyun Bae,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jong Young Choi,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Se Hyun Cho,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Seung Kew Yoon,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • June Yeol Han,

    1. Department of Internal Medicine, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Keun Ho Lee,

    1. Department of Surgery College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Dong Goo Kim,

    1. Department of Surgery College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Eun Sun Jung

    1. Department of Pathology, College of Medicine, WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • This study was supported in part by the 21C Frontier Functional Human Genome Project from the Ministry of Science & Technology, Korea (FG-08-12-05).

Associate Professor Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #505 Banpodong, Seocho-ku, 137-040, Seoul, Korea. Email: garden@catholic.ac.kr

Abstract

Background and Aim:  Little is known about the role of hepatitis B virus (HBV) factors in the long-term prognosis of hepatocellular carcinoma (HCC) after resection. The objective of the present study was to identify the changing patterns of HBV levels and its effect on outcome after resection.

Methods:  This study recruited 188 patients with HBV-related HCC who underwent curative resection. Among the 188 patients, 115 were alive without recurrence at 12 months, and had serial measurements of viral levels.

Results:  The mean age was 53 years and the mean follow-up period was 48.5 months. With multivariate analysis, tumor size > 5 cm (P = 0.047), Child-Pugh class B (P = 0.017), vascular invasion (P = 0.028), and HBV DNA > 104 copies/mL at the time of resection (P = 0.003) were independently predictive of HCC recurrence for the entire population. For the 115 patients with serial measurements of viral levels, tumor size > 5 cm, HBV DNA > 104 copies/mL at resection, and the absence of sustained HBV DNA level < 104 copies/mL, the presence of cirrhosis, and elevated aminotransferase levels (> 40 IU/L) were marginally or significantly associated with HCC recurrence and overall survival. However, on multivariate analysis, sustained HBV DNA level < 104 copies/mL was the only factor for both low recurrence (P = 0.002; odds ratio [OR] 3.13; 95% confidence interval [CI] 1.55–6.35) and longer survival (P = 0.002; OR 3.76; 95% CI 1.61–8.78).

Conclusions:  A high HBV replication state is among the most important predictors of adverse outcome after resection of HBV-related HCC. The sustained suppression of HBV below 104 copies/mL is a strong protective factor for long-term recurrence-free and overall survival.

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