Recurrence of hepatitis B-related hepatocellular carcinoma is associated with high viral load at the time of resection

Abstract

Introduction: To identify the risk factors for recurrence of hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) after resection. Methods: A total of 72 patients who underwent liver resection for HBV-related HCC were recruited. Demographic, biochemical, tumour and viral factors at the time of resection were evaluated by univariate and multivariate analyses to identify risk factors associated with recurrence after resection. Results: The median follow-up period was 18.9 months and the median age was 53 years, with male-to-female ratio of 59:13. Thirty patients developed tumour recurrence. Age >60 years, tumour size >5 cm, poorly differentiated tumour, lymphovascular permeation, the presence of microsatellite lesions, α-fetoprotein (AFP) level >1000 ng/mL and HBV viral load >2000 IU/mL (4 log10 copies/mL) at the time of tumour resection, HBV genotype C, core-promoter mutations and patients with no antiviral treatment after tumour resection were associated with increased cumulative risk of HCC recurrence. By multivariate analysis, HBV viral load >2000 IU/mL (4 log10 copies/mL) [P=0.001; odds ratio [OR]=22.3; 95% CI, 3.3-150.5), AFP >1000 ng/mL (P=0.02; OR=7.4; 95% CI, 2-26.9), tumour size >5 cm (P=0.02; OR=5.1; 95% CI, 1.3-19.8), and age >60 years (P=0.01; OR=4; 95% CI, 1.4-11.1) at the time of tumour resection remained to be the independent risk factors. Conclusions: Viral load of >2000 IU/mL (4 log10 copies/mL) is the most important correctable risk factor for HCC recurrence after resection. Whether antiviral therapy in these patients can decrease tumour recurrence requires further investigations.