Senior Department of Hepatology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
Ann Med. 2022 Dec;54(1):2213-2221. doi: 10.1080/07853890.2022.2107233.
Tumour characteristics and orthotopic liver transplantation (OLT) criteria are risks for recurrence of hepatocellular carcinoma (HCC). In Asia, most HCC is caused by chronic hepatitis B infection. Whether hepatitis B virus DNA (HBV DNA) is a risk factor for HCC recurrence after OLT is not clear.
In this retrospective study, we classified patients into groups of detectable and undetectable HBV DNA, non-HCC recurrence, and recurrence and performed analyses on differed characteristics between groups and risk factors for HCC recurrence after OLT.
Among patients who underwent OLT for HCC, 117 were secondary to CHB infection. CHB was not a risk, but advanced tumour characteristics were risk factor for HCC recurrence. In patients with CHB-HCC, 24 (20.5%) of 117 patients had HCC recurrence. Compared to patients with HBV DNA undetectable ( = 75), patients with detectable HBV DNA ( = 42) had higher AFP concentration ( < .001), higher proportion of macrovascular invasion ( = .014), greater tumour diameter ( < .001), poorer TNM stage ( = .017), and higher proportion of extended OLT criteria ( = .011) and HCC recurrence ( = .036). Preoperative HBV DNA >2000 IU/mL was an independent risk factor for HCC recurrence (OR = 8.35, 95% CI 1.40, 50.00, = .020). HBV DNA detectable was not a risk for HCC-related death.
Individuals with preoperative undetectable HBV DNA had advanced tumour characteristics and a higher proportion of HCC recurrence. Antiviral treatment for HCC should be performed, and HBV DNA undetectable should be obtained before OLT. But for an urgent OLT, preoperative detectable HBV DNA may not affect long-term survival.KEY MESSAGESPatients with HBV DNA detectable had advanced tumour characteristics, a higher proportion of extended OLT criteria, and HCC-recurrence.HBV DNA >2000 IU/mL was a risk factor for HCC recurrence.HBV DNA detectable was not a risk for HCC related death; extended OLT criteria affected long-term survival.
肿瘤特征和原位肝移植（OLT）标准是肝细胞癌（HCC）复发的风险因素。在亚洲，大多数 HCC 是由慢性乙型肝炎感染引起的。HBV DNA 是否是 OLT 后 HCC 复发的危险因素尚不清楚。
在这项回顾性研究中，我们将患者分为可检测和不可检测 HBV DNA、非 HCC 复发和复发组，并对各组之间的不同特征和 OLT 后 HCC 复发的危险因素进行了分析。
在接受 OLT 治疗 HCC 的患者中，有 117 例继发于 CHB 感染。CHB 不是危险因素，但晚期肿瘤特征是 HCC 复发的危险因素。在 CHB-HCC 患者中，117 例中有 24 例（20.5%）发生 HCC 复发。与 HBV DNA 不可检测的患者（n=75）相比，HBV DNA 可检测的患者（n=42）的 AFP 浓度更高（ < .001），大血管侵犯的比例更高（ = .014），肿瘤直径更大（ < .001），TNM 分期更差（ = .017），扩展 OLT 标准的比例更高（ = .011）和 HCC 复发的比例更高（ = .036）。术前 HBV DNA >2000 IU/mL 是 HCC 复发的独立危险因素（OR=8.35，95%CI 1.40，50.00， = .020）。HBV DNA 可检测不是 HCC 相关死亡的危险因素。
术前 HBV DNA 不可检测的个体具有晚期肿瘤特征和更高的 HCC 复发比例。应进行 HCC 的抗病毒治疗，并在 OLT 前获得 HBV DNA 不可检测。但是对于紧急 OLT，术前 HBV DNA 可检测可能不会影响长期生存。
HBV DNA 可检测的患者具有晚期肿瘤特征、更高比例的扩展 OLT 标准和 HCC 复发。HBV DNA >2000 IU/mL 是 HCC 复发的危险因素。HBV DNA 可检测不是 HCC 相关死亡的危险因素；扩展 OLT 标准影响长期生存。
