乙肝病毒脱氧核糖核酸和乙肝表面抗原水平作为乙肝相关肝细胞癌根治性切除术后早期和晚期复发的风险预测指标

HBV DNA and HBsAg levels as risk predictors of early and late recurrence after curative resection of HBV-related hepatocellular carcinoma.

作者信息

Sohn Won, Paik Yong-Han, Kim Jong Man, Kwon Choon Hyuk, Joh Jae Won, Cho Ju Yeon, Gwak Geum-Youn, Choi Moon Seok, Lee Joon Hyeok, Koh Kwang Cheol, Paik Seung Woon, Yoo Byung Chul

机构信息

Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Korea.

出版信息

Ann Surg Oncol. 2014 Jul;21(7):2429-35. doi: 10.1245/s10434-014-3621-x. Epub 2014 Mar 12.

DOI:10.1245/s10434-014-3621-x

PMID:24619495

Abstract

BACKGROUND

Recent studies have shown that high hepatitis B virus (HBV) load is associated with increased risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). The aim of our study was to investigate the predictive role of HBV DNA and hepatitis B surface antigen (HBsAg) levels in early and late recurrence of HCC after curative resection in patients with HBV-related HCC.

METHODS

From January 2008 to December 2010, a total of 248 patients underwent curative resection for HBV-related early-stage HCC (solitary tumor; < 5 cm in diameter or multinodular tumor; number of tumors ≤ 3 and diameter < 3 cm). We analyzed the predictive factors including HBV DNA and HBsAg levels for early recurrence (within 2 years) and late recurrence (after 2 years) of HCC after curative resection.

RESULTS

The median follow-up duration was 33.3 months. Cumulative recurrence rates after resection at 1, 3, and 5 years were 16.6, 34.0, and 46.7 %, respectively. The multivariate analysis showed that risk factors for early recurrence were the presence of microvascular invasion (hazard ratio [HR] 3.86; p < 0.001), preoperative HBV DNA levels ≥ 20,000 IU/mL (HR 2.77; p < 0.001), and des-γ-carboxy prothrombin level ≥ 40 mAU/mL (HR 1.76; p = 0.045). Although, the risk factors for late recurrence by multivariate analysis were preoperative HBsAg levels ≥ 4,000 IU/mL (HR 2.80; p = 0.023) and age at resection ≥ 50 years (HR 3.22; p = 0.032).

CONCLUSION

The HBV DNA levels were associated with early recurrence, whereas HBsAg levels were associated with late recurrence after curative resection in HBV-related HCC.

摘要

背景

近期研究表明，慢性乙型肝炎（CHB）患者中，高乙肝病毒（HBV）载量与肝细胞癌（HCC）风险增加相关。我们研究的目的是调查HBV DNA和乙肝表面抗原（HBsAg）水平对HBV相关HCC患者根治性切除术后HCC早期和晚期复发的预测作用。

方法

2008年1月至2010年12月，共有248例患者接受了HBV相关早期HCC的根治性切除（孤立肿瘤；直径<5 cm或多结节肿瘤；肿瘤数量≤3且直径<3 cm）。我们分析了包括HBV DNA和HBsAg水平在内的预测因素，以评估根治性切除术后HCC早期复发（2年内）和晚期复发（2年后）情况。

结果

中位随访时间为33.3个月。切除术后1、3和5年的累积复发率分别为16.6%、34.0%和46.7%。多因素分析显示，早期复发的危险因素为微血管侵犯（风险比[HR] 3.86；p<0.001）、术前HBV DNA水平≥20,000 IU/mL（HR 2.77；p<0.001）和去γ-羧基凝血酶原水平≥40 mAU/mL（HR 1.76；p = 0.045）。尽管多因素分析显示，晚期复发的危险因素为术前HBsAg水平≥4,000 IU/mL（HR 2.80；p = 0.023）和切除时年龄≥50岁（HR 3.22；p = 0.032）。