Sohn W, Paik Y-H, Cho J Y, Ahn J Ma, Choi G S, Kim J M, Kwon C H, Joh J W, Sinn D H, Gwak G-Y, Choi M S, Lee J H, Koh K C, Paik S W, Yoo B C
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Viral Hepat. 2015 Jun;22(6):539-50. doi: 10.1111/jvh.12356. Epub 2014 Nov 7.
It is unclear whether the reactivation of hepatitis B virus (HBV) influences the prognosis of hepatocellular carcinoma (HCC) after resection in patients with chronic hepatitis B. The aim of this study was to identify the influence of HBV reactivation on the recurrence of hepatitis B-related HCC after curative resection in patients with low viral load (HBV DNA <2000 IU/mL). We retrospectively analysed a total of 130 patients who underwent curative resection for HBV-related early stage HCC (single nodule; <5 cm/two or three nodules; <3 cm) with pre-operative HBV DNA levels <2000 IU/mL with serial HBV DNA tests. The predictive factors including HBV reactivation for the recurrence of HBV-related HCC after curative resection were investigated. Fifty-three patients (41%) had HBV reactivation after resection among 130 patients. HBV reactivation was observed in 22 of 53 patients with undetectable baseline HBV DNA and in 31 of 77 patients with detectable baseline HBV DNA. Cumulative recurrence rates after resection at 1, 2 and 3 years were 17.0%, 23.3% and 31.4%, respectively. The multivariable analysis demonstrated that the risk factors for the recurrence were the presence of microvascular invasion (hazard ratio (HR) 2.62, P = 0.003), multinodularity (HR 4.61, P = 0.005), HBV reactivation after resection (HR 2.03, P = 0.032) and HBeAg positivity (HR 2.06, P = 0.044). HBV reactivation after curative resection is associated with the recurrence of HBV-related HCC in patients with low viral load.
慢性乙型肝炎患者切除术后乙肝病毒（HBV）再激活是否会影响肝细胞癌（HCC）的预后尚不清楚。本研究的目的是确定低病毒载量（HBV DNA<2000 IU/mL）的患者根治性切除术后HBV再激活对乙肝相关HCC复发的影响。我们回顾性分析了130例行根治性切除的乙肝相关早期HCC（单个结节；<5 cm/两个或三个结节；<3 cm）患者，术前HBV DNA水平<2000 IU/mL，并进行了系列HBV DNA检测。研究了包括HBV再激活在内的根治性切除术后乙肝相关HCC复发的预测因素。130例患者中，53例（41%）术后出现HBV再激活。53例基线HBV DNA检测不到的患者中有22例出现HBV再激活，77例基线HBV DNA可检测到的患者中有31例出现HBV再激活。术后1、2和3年的累积复发率分别为17.0%、23.3%和31.4%。多变量分析表明，复发的危险因素包括微血管侵犯（风险比（HR）2.62，P = 0.003）、多结节性（HR 4.61，P = 0.005）、术后HBV再激活（HR 2.03，P = 0.032）和HBeAg阳性（HR 2.06，P = 0.044）。低病毒载量患者根治性切除术后HBV再激活与乙肝相关HCC的复发有关。
