Department of Medical Research and Education, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
J Hepatol. 2009 Nov;51(5):890-7. doi: 10.1016/j.jhep.2009.07.009. Epub 2009 Jul 23.
BACKGROUND/AIMS: Hepatitis B virus (HBV) levels correlate with the development of hepatocellular carcinoma (HCC), but the role of viral load in HCC recurrence after tumor resection remains unclear. Herein we aimed to investigate the role of viral load in HCC recurrence following tumor resection.
From 1990 to 2002, 193 HBV-related HCC patients who underwent tumor resection in Taipei Veterans General Hospital were enrolled. Serum HBV DNA level and mutations were analyzed for association with early and late recurrence, together with other clinical variables.
During a follow-up of 58.2+/-44 months, 134 patients had HCC recurrence. Multivariate analysis showed that multinodularity (Hazard ratio [HR], 95% confidence interval [CI]; 2.232, 1.021-4.878), macroscopic venous invasion (4.693, 1.645-13.391), AFP >20 ng/ml (3.891, 1.795-8.475), and cut margin <or= 1cm (3.333, 1.487-7.470) were correlated with early recurrence (within two years of operation) of HCC. In addition, multivariate analysis determined that Ishak hepatic inflammatory activity >6 (4.658, 1.970-11.017), multinodularity (3.266, 1.417-7.526), ICG-15 >10% (2.487, 1.095-5.650) and HBV DNA level >10(6) copies/ml (2.548, 1.040-6.240) were significantly associated with late recurrence (>two years after resection). Patients with high viral loads tended to have higher Ishak inflammatory (7.00+/-3.07 vs. 5.33+/-2.96, p=0.001) and fibrosis scores (4.17+/-2.01 vs. 3.20+/-2.41, p=0.007) than those with lower loads.
Tumor factors were associated with early HCC recurrence while high viral loads and hepatic inflammatory activity were associated with late recurrence. Pre- and post-operative antiviral and anti-inflammatory therapies may be crucial in reducing late recurrence.
背景/目的：乙型肝炎病毒 (HBV) 载量与肝细胞癌 (HCC) 的发生发展相关，但病毒载量在肿瘤切除术后 HCC 复发中的作用尚不清楚。本研究旨在探讨病毒载量在 HCC 切除术后复发中的作用。
1990 年至 2002 年，共纳入 193 例在台北荣民总医院接受肿瘤切除术的 HBV 相关性 HCC 患者。分析血清 HBV DNA 水平和突变与早期和晚期复发的关系，并与其他临床变量进行比较。
在 58.2±44 个月的随访中，134 例患者出现 HCC 复发。多因素分析显示，多结节性 (危险比 [HR]，95%置信区间 [CI]；2.232，1.021-4.878)、肉眼静脉侵犯 (4.693，1.645-13.391)、AFP >20ng/ml (3.891，1.795-8.475) 和切缘<或=1cm (3.333，1.487-7.470) 与 HCC 的早期复发（术后两年内）相关。此外，多因素分析还确定 Ishak 肝炎症活动度>6 (4.658，1.970-11.017)、多结节性 (3.266，1.417-7.526)、ICG-15>10% (2.487，1.095-5.650) 和 HBV DNA 载量>10(6) 拷贝/ml (2.548，1.040-6.240) 与晚期复发（切除后两年以上）显著相关。高病毒载量患者的 Ishak 炎症评分 (7.00±3.07 与 5.33±2.96，p=0.001) 和纤维化评分 (4.17±2.01 与 3.20±2.41，p=0.007) 均高于低病毒载量患者。
肿瘤因素与 HCC 的早期复发相关，而高病毒载量和肝炎症活动度与晚期复发相关。术前和术后的抗病毒和抗炎治疗可能对降低晚期复发至关重要。
