Persistent hepatitis B viral replication affects recurrence of hepatocellular carcinoma after curative resection

Authors

  • Beom Kyung Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Jun Yong Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Do Young Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
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  • Ja Kyung Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
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  • Kyung Sik Kim,

    1. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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  • Jin Sub Choi,

    1. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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  • Byung Soo Moon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang Hyub Han,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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  • Chae Yoon Chon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
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  • Young Myoung Moon,

    1. Department of Internal Medicine, Kwandong University College of Medicine, Koyang, Korea
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  • Sang Hoon Ahn

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
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Correspondence
Sang Hoon Ahn, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea
Tel: +82 2 2228 1971
Fax: +82 2 393 6884
e-mail: ahnsh@yumc.yonsei.ac.kr

Abstract

Background: Elevated serum hepatitis B virus (HBV) DNA increases the development of hepatocellular carcinoma (HCC). Rather than instantaneous DNA level, the duration of persistent HBV replication is more important in carcinogenesis. Nevertheless, most investigators evaluated the DNA level at study entry. We assessed the effects of persistently detectable serum HBV DNA on HCC recurrence.

Patients and methods: We included 230 consecutive patients undergoing curative resection between 2000 and 2006. Patients who had antiviral therapy (at diagnosis or during follow-up), fluctuating DNA (cut-off value: 100 000 copies/ml) or recurrence within 12 months of resection were excluded. Ultimately, 157 were enrolled: 89 (non-viraemia group) had consistently negative DNA (<100 000 copies/ml), while 68 (viraemia group) had consistently positive DNA (>100 000copies/ml). Serum DNA level, biochemical tests, α-foetoprotein (AFP) and liver dynamic computed tomography were obtained every 3 months after surgery.

Results: There were no significant differences in age, gender, liver function, histology, AFP, tumour stages or follow-up duration between the two groups. During follow-up (median: 35 months), patients in the non-viraemia group had a lower 5-year cumulative recurrence rate (54.7%) than those in the viraemia group (72.9%; P=0.043). In multivariate analysis, sustained viraemia (P=0.041) increased recurrence independently.

Conclusions: Persistent viraemia increased recurrence independently after surgery. To prevent long-term recurrences, antiviral therapy should be initiated in those with detectable serum HBV DNA.

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