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Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B

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Abstract

We examineded the clinical effects of serum hepatitis B e antigen (HBeAg) positivity on clinicopathologic findings and prognosis after liver resection for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. A series of 56 patients who underwent curative resection were divided into two groups: 25 HBeAg-positive patients (group 1) and 31 HBeAg-negative patients (group 2). The mean age was significantly lower in group 1 than in group 2 (p=0.0021), and the proportion of patients with symptoms was significantly higher in group 1 than in group 2 (p=0.037). There were no significant differences in other clinical findings between the two groups, including laboratory test results, coexisting medical conditions, and operative methods. Although tumor size, degree of differentiation of the main tumor, and the prevalence of vascular invasion did not differ between the groups, the prevalence of intrahepatic metastasis and the proportion of patients with active hepatitis were significantly higher in group 1 than in group 2 (p=0.009 and p=0.043, respectively). Tumor-free and cumulative survival rates were significantly lower in group 1 than in group 2 (p=0.022 and p=0.0001, respectively). Multivariate analysis of various possible risk factors demonstrated serum HBeAg positivity to be an independent risk factor for recurrence [risk ratio (RR) 2.49; 95% confidence interval (CI) 1.12–5.49; p=0.032] and an independent unfavorable factor for the survival time (RR 7.58; 95% CI 2.10–27.8; p=0.0020). We concluded that the prognosis after liver resection for HCC is worse for HBeAg-positive patients than for HBeAg-negative patients.

Résumé

Chez des patients ayant une hépatite chronique B, et une résection hépatique pour carcinome hépatocellulaire (CHC), on a cherché à connatre le retentissement clinique (basé sur les données pathocliniques et pronostique) de la positivité de l’antigène de l’hépatite Be (HBeAg) dans le sérum. Cinquante-six patients qui ont eu une résection à visée curative ont été divisés en deux groupes: 25 patients HBeAg-positifs (groupe 1) et 31 patients HBeAg-négatifs (groupe 2). L’âge moyen a été significativement plus bas dans le groupe 1 que dans le groupe 2 (p=0.0021). La proportion de patients symptomatiques a été significativement plus élevée dans le groupe 1 que dans le groupe 2 (p=0.037). Il n’y avait aucune différence significative entre les deux groupes en ce qui concerne les autres données cliniques, y compris les résultats de laboratoire, les autres conditions médicales ou des méthodes opératoires. Bien que la taille tumorale, le degrhe de dédifférenciation de la tumeur principale et la prévalence de l’invasion vasculaire ne différaient pas entre les deux groupes, la prévalence de métastases intrahépatiques et la proportion de patients avec une hépatite active étaient significativement plus élevées dans le groupe 1 que dans le group 2 (p=0.0009, p=0.043, respectivement). Les taux de survie sans tumeur et cumulative étaient significativement plus bas dans le groupe 1 que dans le groupe 2 (respectivement, p=0.022 et p=0.0001). En analyse multivariée des potentiels facteur de risque, la positivité de l’HBeAg dans le sérum est un facteur de risque indépendant pour la récidive (rapport de côte: 2.49; Cl 95%, 1.12–5.49; p=0.032) et un facteur défavorable indépendant de survie (7.58, 2.10–27.8, p=0.0020). Nous concluons que, en cas de résection du foie pour CHC, le pronostic est plus mauvais chez les patients HBeAg-positifs que chez les patients HBeAg-négatifs.

Resumen

En enfermos con hepatitis crónica B, tras resección hepática por hepatocarcinoma celular, se investigan los efectos clínicos del antígeno sérico positivo de hepatitis. Be (HBeAg) tanto sobre los hallazgos clínco-patológicos como por lo que al pronóstico atañe. 56 pacientes, sometidos a una resección curativa, se dividieron en dos grupos: grupo 1: 25 pacientes con HBeAg positivo y grupo 2: 31 pacientes con HBeAg negativo. La edad media fue signifcativamente menor en el grupo 1 que en el 2 (p=0.0021). El número de pacientes con sintomatología fue significativamente mayor en el grupo 1 que en el 2 (p=0.037). Entre ambos grupos no se registraron otras diferencias significativas, ni en los hallazgos clínicos, incluyendo los análisis de laboratorio, ni en afecciones médicas coexistentes, ni en los métodos operatorios. Aunque el tamaño del tumor, grado de diferenciación de la neoplasia principia, y predominio de la invasión vascular no fueron diferentes entre ambos grupos, la frecuencia de metástasis intrahepáticas y el número de pacientes con hepatitis activa fue significativamente mayor en el grupo 1 (p=0.0009) que en el 2 (p=0.043). Los porcentajes de pacientes libres de enfermedad tumoral y los de supervivencia fueron significativamente menores en el grupo 1 (p=0.022) que en el grupo 2 (p=0.0001). Los análisis multivariates de varios posibles factores de riesgo demostraron que la positividad sérica del HBeAg constituye un factor de riesgo independiente para la recidiva (cociente de riesgo, 2.49; 95% CI, 1.12–5.49, p=0.032) y un factor independiente desfavorable por lo que al tiempo de supervivencia se refiere (7.58, 2.10–27.8, p=0 .0020). Conclusión: El pronóstico para pacientes con HCC tras resección hepática es peor para los enfermos con HBeAg positivo que para los HBeAg-negativos.

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Authors and Affiliations

  1. Second Department of Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, 545-8585, Osaka, Japan

    Shoji Kubo M.D., Kazuhiro Hirohashi M.D., Hiromu Tanaka M.D., Taichi Shuto M.D., Takatsugu Yamamoto M.D., Shuichi Kawai M.D. & Hiroaki Kinoshita M.D.

  2. Department of Gastrointestinal Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, 534-0021, Osaka, Japan

    Osamu Yamazaki M.D., Mitsuharu Matsuyama M.D. & Katsuhiko Horii M.D.

  3. Department of Pathology, Osaka City University Hospital, 1-5-7 Asahimachi, Abeno-ku, 545-8586, Osaka, Japan

    Kenichi Wakasa M.D.

  4. Third Department of Internal Medicine, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, 545-8585, Osaka, Japan

    Shuhei Nishiguchi M.D.

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  1. Shoji Kubo M.D.
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  2. Kazuhiro Hirohashi M.D.
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  3. Osamu Yamazaki M.D.
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  4. Mitsuharu Matsuyama M.D.
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  5. Hiromu Tanaka M.D.
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  6. Katsuhiko Horii M.D.
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  7. Taichi Shuto M.D.
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  8. Takatsugu Yamamoto M.D.
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  9. Shuichi Kawai M.D.
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  10. Kenichi Wakasa M.D.
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  11. Shuhei Nishiguchi M.D.
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  12. Hiroaki Kinoshita M.D.
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Correspondence to Shoji Kubo M.D..

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Published Online: February 12, 2002

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Kubo, S., Hirohashi, K., Yamazaki, O. et al. Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B. World J. Surg. 26, 555–560 (2002). https://doi.org/10.1007/s00268-001-0267-1

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