Hepatobiliary Tumors

Annals of Surgical Oncology

, Volume 20, Issue 5, pp 1482-1490

Early Viral Suppression Predicts Good Postoperative Survivals in Patients with Hepatocellular Carcinoma with a High Baseline HBV-DNA Load

  • Gang HuangAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
  • , Yuan YangAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
  • , Feng ShenAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
  • , Ze-ya PanAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
  • , Si-yuan FuAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
  • , Wan Yee LauAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityFaculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital
  • , Wei-ping ZhouAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University Email author 
  • , Meng-chao WuAffiliated withThe Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University

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Abstract

Purpose

To correlate early HBV-DNA suppression by antiviral treatment with posthepatectomy long-term survivals in patients with HBV-related hepatocellular carcinoma (HCC).

Methods

A retrospective study was conducted on patients with a baseline HBV-DNA load of >2,000 IU/ml. The cumulative rates of HBV-DNA undetectability at weeks 24 and 48, as well as long-term tumor recurrence and overall survivals were determined.

Results

Of 1,040 patients with a high baseline HBV-DNA load, 865 patients received antiviral treatment. At a median follow-up of 42 months, 616 patients (59.2 %) had developed HCC recurrence and 482 patients (46.3 %) had died. The median time to recurrence was 25 months. In patients who received antiviral treatment, the cumulative rates of HBV-DNA undetectability (<200 IU/ml) were 54.3 and 88.1 % at weeks 24 and 48, respectively. There was no significant difference between the two groups of patients who received antiviral treatment or not for disease-free survival. On multivariate analyses, tumor size >5 cm, blood transfusion, surgical margin <1 cm, presence of satellite nodules, presence of portal vein tumor thrombus and high Ishak inflammation score were significant risk factors of HCC recurrence. Also, tumor size >5 cm, surgical margin <1 cm, presence of satellite nodules, presence of portal vein tumor thrombus and high Ishak fibrosis score were significant factors associated with poor postoperative overall survival. On the other hand, an undetectable HBV-DNA level before week 24 was a significant protective factor of disease-free survival and overall survival.

Conclusions

Early HBV-DNA suppression with antiviral treatment improved prognosis of patients with HBV-related HCC.