Liu Wei-Ren, Tian Meng-Xin, Jin Lei, Yang Liu-Xiao, Ding Zhen-Bin, Shen Ying-Hao, Peng Yuan-Fei, Zhou Jian, Qiu Shuang-Jian, Dai Zhi, Fan Jia, Shi Ying-Hong
Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Ann Surg Oncol. 2015 Mar;22(3):843-50. doi: 10.1245/s10434-014-4043-5. Epub 2014 Oct 1.
Recurrence is a disastrous outcome in patients with hepatitis-related hepatocellular carcinoma (HCC) who have undergone curative resection, and little is known about whether high levels of hepatitis B surface antigen (HBsAg) increase the risk of HCC recurrence.
This retrospective study included 1,360 HBsAg-positive postoperative HCC patients with hepatitis B viral (HBV) DNA levels < 2000 IU/mL, including 298 patients in a training cohort and 1,062 patients in a validation cohort. The prognostic value of the HBsAg level was evaluated using Cox regression and Kaplan-Meier analyses.
We demonstrated that 1,000 IU/mL, but not 10 or 100 IU/mL, was a meaningful cutoff level for significantly discriminating these patients into an HBsAg(Low) group and an HBsAg(High) group based on correlations between the HBsAg level and liver cirrhosis (p = 0.028), tumor size (p = 0.039), and hepatitis B e antigen level (p < 0.001). The postoperative 1-, 3-, and 5-year overall survival (OS) rates of HCC patients in the HBsAg(Low) group were significantly higher than those of HCC patients in the HBsAg(High) group. Accordingly, the 5-year recurrence-free survival (RFS) rates of patients in the HBsAg(Low) group were markedly higher than those of HCC patients in the HBsAg(High) group. The HBsAg level was a prognostic indicator for OS (p = 0.014) and RFS (p = 0.01).
HBsAg level is correlated with more aggressive tumor behavior and serves as a prognostic indicator in patients with surgically resected HCC with low HBV load.
复发是接受根治性切除的肝炎相关肝细胞癌（HCC）患者的灾难性结局，关于高水平乙肝表面抗原（HBsAg）是否会增加HCC复发风险，目前知之甚少。
这项回顾性研究纳入了1360例术后HBsAg阳性且乙肝病毒（HBV）DNA水平<2000 IU/mL的HCC患者，其中298例患者纳入训练队列，1062例患者纳入验证队列。使用Cox回归和Kaplan-Meier分析评估HBsAg水平的预后价值。
我们证明，基于HBsAg水平与肝硬化（p = 0.028）、肿瘤大小（p = 0.039）和乙肝e抗原水平（p < 0.001）之间的相关性，1000 IU/mL是将这些患者显著区分为HBsAg（低）组和HBsAg（高）组的有意义的临界值水平，而10或100 IU/mL并非如此。HBsAg（低）组HCC患者的术后1年、3年和5年总生存率（OS）显著高于HBsAg（高）组HCC患者。相应地，HBsAg（低）组患者的5年无复发生存率（RFS）明显高于HBsAg（高）组HCC患者。HBsAg水平是OS（p = 0.014）和RFS（p = 0.01）的预后指标。
HBsAg水平与更具侵袭性的肿瘤行为相关，并可作为低HBV载量的手术切除HCC患者的预后指标。
