Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B

Abstract

We examineded the clinical effects of serum hepatitis B e antigen (HBeAg) positivity on clinicopathologic findings and prognosis after liver resection for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. A series of 56 patients who underwent curative resection were divided into two groups: 25 HBeAg-positive patients (group 1) and 31 HBeAg-negative patients (group 2). The mean age was significantly lower in group 1 than in group 2 (p = 0.0021), and the proportion of patients with symptoms was significantly higher in group 1 than in group 2 (p = 0.037). There were no significant differences in other clinical findings between the two groups, including laboratory test results, coexisting medical conditions, and operative methods. Although tumor size, degree of differentiation of the main tumor, and the prevalence of vascular invasion did not differ between the groups, the prevalence of intrahepatic metastasis and the proportion of patients with active hepatitis were significantly higher in group 1 than in group 2 (p = 0.009 and p = 0.043, respectively). Tumor-free and cumulative survival rates were significantly lower in group 1 than in group 2 (p = 0.022 and p = 0.0001, respectively). Multivariate analysis of various possible risk factors demonstrated serum HBeAg positivity to be an independent risk factor for recurrence [risk ratio (RR) 2.49; 95% confidence interval (CI) 1.12-5.49; p = 0.032] and an independent unfavorable factor for the survival time (RR 7.58; 95% CI 2.10-27.8; p = 0.0020). We concluded that the prognosis after liver resection for HCC is worse for HBeAg-positive patients than for HBeAg-negative patients.

Clinicopathologic Features and Outcome After Liver Resection for Hepatocellular Carcinoma in Patients with Concurrent Versus Previous Chronic Hepatitis B

“…36,37 Patients in the immuneclearance phase of chronic hepatitis B infection are at high risk of HCC recurrence after the operation. In this study, only group A included such patients, which explains why chronic hepatitis B status, tumor factors, and the type of operation affected recurrence, whereas in group B only tumor factors affected recurrence.…”

Favorable long‐term surgical outcomes of hepatocellular carcinoma in patients with hepatitis B envelope antibody

“…There have been only a few reports on outcomes after hepatectomy for small HCC in relation to the HB envelope [6,7]. In the present study, favorable long-term surgical outcomes were achieved in patients with HBV-related HCC within the Milan criteria and positive HBe-Ab.…”

“…Therefore, the higher carcinogenesis of HCC or poorer prognosis in patients who are positive for HBe-Ag than in patients who are negative for HBe-Ag has been reported [1]. Furthermore, poorer surgical outcomes after hepatectomy for small HCC in patients who are positive for HBe-Ag than in patients who are negative for HBe-Ag have been reported [6,7] However, there have been no previous reports of surgical outcomes of HCC within Milan criteria in relation to the HB envelope. In this study, lower risk of recurrence and longer survival were seen in patients who were positive for HBe-Ab than in patients who were negative for HBe-Ab.…”

“…Higher HBV viral loads are strongly associated with the development of HCC and recurrence of HCC after surgery, and serum hepatitis B envelope antigen (HBe-Ag) is a simple surrogate marker of HBV-DNA [1][2][3][4][5]. Moreover, in patients with HBV-related small HCC, higher rates of intrahepatic recurrence of HCC and poorer survival in patients who were positive for HBe-Ag than in those who were negative for HBe-Ag have also been reported [6,7]. However, there have been no previous reports of surgical outcomes of HCC within Milan criteria in relation to the HB envelope.…”

Prevention of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Virus Infection

“…As mentioned above, because viral replication reflected as sustained HBeAg positivity and a high viral load adversely affects the development of HCC, it is reasonable to suggest that viral replication may also facilitate de novorecurrence in the remnant liver. Several studies support this hypothesis, but the detailed effects of viral replication on recurrence differ somewhat among studies [52,53,54,55,56,57,58]. Sun et al [56] reported that a positive serum HBeAg was associated with a higher risk of early recurrence (within 1 year) rather than late recurrence.…”