乙型肝炎病毒 DNA 水平低和术前乙型肝炎表面抗原水平高的患者肝癌复发的预测。

Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels.

机构信息

Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.

Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China2Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.

出版信息

JAMA Surg. 2014 Jun;149(6):519-27. doi: 10.1001/jamasurg.2013.4648.

DOI:10.1001/jamasurg.2013.4648

PMID:24696192

Abstract

IMPORTANCE

In patients with low viral loads, high levels of hepatitis B surface antigen (HBsAg) have been shown to predict development of hepatocellular carcinoma (HCC). Whether high levels of HBsAg increase the risk for HCC recurrence after hepatic resection remains unknown.

OBJECTIVE

To investigate the association between levels of HBsAg and the risk for tumor recurrence after curative resection in HCC patients with low levels of hepatitis B virus (HBV) DNA.

DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective analysis of the clinical data of 1062 patients with low HBV DNA levels (<200 IU/mL) who underwent partial hepatectomy for HCC. In particular, we investigated the association between levels of HBsAg and recurrence of HCC.

EXPOSURE

Partial hepatectomy for HCC.

MAIN OUTCOMES AND MEASURES

The risk for first tumor recurrence between patients with high and low HBsAg levels. We calculated cumulative incidences and hazard ratios after adjusting for competing mortality.

RESULTS

The risk for tumor recurrence increased with HBsAg levels of 1000 IU/mL or greater. When we compared the groups with low (<1000 IU/mL) and high (≥1000 IU/mL) HBsAg levels, the 5-year disease-free survival rate (46.1% vs 34.1% [P = .002]) and the overall survival rate (57.5% vs 48.8% [P = .004]) were better in the group with low HBsAg levels. On multivariate analysis, hepatitis B e antigen seropositivity, HBsAg level of 1000 IU/mL or greater, tumor size of greater than 5 cm, blood transfusion, surgical margin of less than 1.0 cm, the presence of satellite nodules, and the presence of portal vein tumor thrombus were independent risk factors for HCC recurrence. When compared with hepatitis B e antigen status, HBsAg level better predicted recurrence of HCC.

CONCLUSIONS AND RELEVANCE

A preoperative HBsAg level of 1000 IU/mL or greater is an independent risk factor for HCC recurrence in patients with low HBV DNA levels.

摘要

重要性

在病毒载量低的患者中，高水平的乙肝表面抗原（HBsAg）已被证明可预测肝细胞癌（HCC）的发生。HBsAg 水平升高是否会增加 HCC 切除术后复发的风险尚不清楚。

目的

研究 HBV DNA 水平低的 HCC 患者中 HBsAg 水平与 HCC 切除术后肿瘤复发风险之间的关系。

设计、设置和参与者：我们对 1062 例 HBV DNA 水平低（<200 IU/mL）接受 HCC 部分肝切除术的患者的临床数据进行了回顾性分析。特别是，我们研究了 HBsAg 水平与 HCC 复发之间的关系。

暴露

HCC 部分肝切除术。

主要结果和措施

高和低 HBsAg 水平患者的首次肿瘤复发风险。我们在调整竞争死亡率后计算了累积发生率和风险比。

结果

随着 HBsAg 水平达到 1000 IU/mL 或更高，肿瘤复发的风险增加。当我们比较 HBsAg 水平低（<1000 IU/mL）和高（≥1000 IU/mL）的两组时，低 HBsAg 水平组的 5 年无病生存率（46.1%比 34.1%[P = .002]）和总生存率（57.5%比 48.8%[P = .004]）更好。多因素分析显示，乙型肝炎 e 抗原阳性、HBsAg 水平≥1000 IU/mL、肿瘤直径>5 cm、输血、手术切缘<1.0 cm、卫星结节、门静脉癌栓存在是 HCC 复发的独立危险因素。与乙型肝炎 e 抗原状态相比，HBsAg 水平能更好地预测 HCC 的复发。