Influence of hepatitis B virus DNA elevation on recurrence of hepatocellular carcinoma after surgical resection and the preventive role of antiviral therapy

초록

Aims: This study aimed to investigate the influence of HBV DNA eleva-tion on HCC recurrence and the preventive role of antiviral therapy. Methods:One hundred forty-four patients who had Barcelona Clinic Liver Cancer stage 0 or A and received surgical resection as primary therapy were enrolled. HBV DNA elevation was defined as reactivation in patients without preoperative antivirals or virologic breakthrough in patients with preoperative antivirals. Results: Overall 1-year, 3-year, and 5-year recur-rence was 20.1%, 33.3%, and 45.1%, respectively. In multivariate analysisfor risk factors of recurrence, multiple tumor and HBV DNA elevation,ALT≥30, were independently associated with HCC recurrence. Multiple tumor and HBV DNA elevation were independent risk factors for HCC recurrence irrespective of preoperative antiviral therapy. In multivariate analysis for risk factors of HBV DNA elevation, age<50 years, no preoperative antivirals, and HBV DNA≥2000 remained as risk factors. Risk factors for HBV DNA elevation were further analyzed in patients without preoperative antivirals. Age<50 years, HBV DNA≥2000 IU/mL, hepatitis B e antigen positivity, and delayed antiviral therapy were independent risk factors for HBV DNA elevation. Conclusion: Hepatitis B virus DNA elevation after resection increases the risk of HCC recurrence irrespective of preoperative antivirals. However, HBV DNA elevation is an independent risk factor for recurrence in patients without preoperative antivirals. Therefore, antiviral therapy should be considered to prevent HBV DNA elevation and HCC recurrence, especially in patients with age<50 years and/or HBV DNA≥2000 IU/mL and/or hepatitis B e antigen positivity.