High Hepatitis B Viral Load Predicts Recurrence of Small Hepatocellular Carcinoma after Curative Resection

Abstract

A retrospective cohort study was conducted to identify risk factors for recurrence of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative resection. A total of 317 patients who had received curative resection of pathologically proven small HCC (< or = 3 cm in diameter) were analyzed to ascertain the factors affecting recurrence. The median follow-up period was 33.7 months. Cumulative recurrence rates at 1, 3, and 5 years after resection were 23.5%, 49.5%, and 65.5%, respectively. Male sex, alpha-fetoprotein (AFP) > or = 400 ng/mL, HBV DNA level > or = 4 log(10) copies/mL, prolonged prothrombin time, tumor size > or = 2 cm, microvascular invasion, absence of capsular formation, moderate/poor tumor differentiation, and absence of postoperative interferon-alpha (IFN-alpha) treatment were associated with increased cumulative risk of HCC recurrence. By multivariate analysis, HBV DNA level > or = 4 log(10) copies/mL (P < 0.001, hazard ratio (HR) 2.110), AFP > or = 400 ng/mL (P = 0.011, HR 1.574), microvascular invasion (P < 0.001, HR 1.767), and postoperative IFN-alpha treatment (P = 0.022, HR 0.562) remained to be independently associated with HCC recurrence. Those contributing to late recurrence (>2 years) were older age and HBV DNA level > or = 4 log(10) copies/mL. Patients with persistent HBV DNA level > or = 4 log(10) copies/mL at resection and follow-up had the highest recurrence risk (P < 0.001, HR 4.129). HBV DNA level > or = 4 log(10) copies/mL at the time of resection was the most important risk factor for recurrence. Postoperative IFN-alpha treatment significantly decreased the recurrence risk after resection.

Adjuvant Therapy after Curative Resection for Hepatocellular Carcinoma Associated with Hepatitis Virus

“…Since we first reported that a high serum concentration of HBV DNA before surgery is a strong risk factor for HCC recurrence after curative resection for HBV-related HCC [4,10] , several studies have found similar results [11][12][13][14][15][16][17] . We also demonstrated that the lack of an acute exacerbation of hepatitis and a sustained low serum concentration of HBV DNA after surgery were significantly associated with a low risk for HCC recurrence [16] .…”

Methylation of tissue factor pathway inhibitor 2 as a prognostic biomarker for hepatocellular carcinoma after hepatectomy

“…31 The impact of viral factors on the recurrence of HCC after hepatectomy may be overshadowed by tumor-related factors during the early recurrence. 32 In conclusion, TFPI2 methylation in HCC plays a critical role in tumor invasion and progression. We provide evidence that TFPI2 methylation may be a predictor for poor postoperative outcomes and early tumor recurrence in patients with HCC after hepatectomy.…”

The progress and prospects of routine prophylactic antiviral treatment in hepatitis B-related hepatocellular carcinoma

“…High hepatitis B viral load may suppress immunologic surveillance of cancer cells, leading to a higher recurrence risk. However, according several studies, a postoperative IFN-alpha antiviral treatment or a NAs therapy can significantly lower the rate of recurrence after hepatectomy [24][25][26][27]. Several other studies dispute this and, instead, found that antiviral treatment with nucleoside analogs failed to reduce the shortterm recurrence rate of postoperative patients with HBV-related HCC.…”