Shen J, Liu J, Li C, Wen T, Yan L, Yang J
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
J Viral Hepat. 2018 Sep;25(9):1057-1065. doi: 10.1111/jvh.12911. Epub 2018 May 17.
The effects of serum hepatitis B e antigen (HBeAg) on the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy remain controversial. Our aim was to explore the prognostic significance of serum HBeAg on the prognosis of patients with HCC using a propensity matching model. Between January 2009 and March 2015, 953 patients with HCC who underwent hepatectomy in West China Hospital were analysed. Propensity matching analysis was applied, and survival analysis was performed using the Kaplan-Meier method. Risk factors were identified by the Cox proportional hazards model. All patients with HCC were classified into an HBeAg(-) group (n = 775, 81.3%) or an HBeAg(+) group (n = 178, 18.7%). Patients with positive serum HBeAg had poorer recurrence-free survival and overall survival before and after propensity matching. Similar results were found in patients within the Milan criteria. For patients beyond the Milan criteria, the HBeAg(+) group had poor overall survival before and after propensity matching. In term of recurrence-free survival, there was no statistically significant impact after propensity matching (P = .055), although there was a trend for HBeAg(+) patient to have reduced recurrence-free survival. Positive serum HBeAg, positive HBV-DNA load, largest tumour size, multiple tumours, microvascular invasion and a high serum level of preoperative alpha-fetoprotein were risk factors for recurrence. Our propensity model confirmed that positive serum HBeAg had a negative impact on the recurrence and long-term survival irrespective of tumour stages. HBeAg seroconversion might be beneficial for reducing the rate of recurrence.
血清乙肝e抗原（HBeAg）对肝细胞癌（HCC）患者肝切除术后预后的影响仍存在争议。我们的目的是使用倾向匹配模型探讨血清HBeAg对HCC患者预后的预后意义。分析了2009年1月至2015年3月期间在华西医院接受肝切除术的953例HCC患者。应用倾向匹配分析，并采用Kaplan-Meier法进行生存分析。通过Cox比例风险模型确定危险因素。所有HCC患者分为HBeAg（-）组（n = 775，81.3%）或HBeAg（+）组（n = 178，18.7%）。血清HBeAg阳性的患者在倾向匹配前后的无复发生存率和总生存率较差。在米兰标准内的患者中也发现了类似结果。对于超出米兰标准的患者，HBeAg（+）组在倾向匹配前后的总生存率较差。在无复发生存方面，倾向匹配后虽有HBeAg（+）患者无复发生存率降低的趋势，但无统计学显著影响（P = 0.055）。血清HBeAg阳性、HBV-DNA载量阳性、最大肿瘤大小、多发肿瘤、微血管侵犯和术前血清甲胎蛋白水平高是复发的危险因素。我们的倾向模型证实，无论肿瘤分期如何，血清HBeAg阳性对复发和长期生存均有负面影响。HBeAg血清学转换可能有利于降低复发率。
