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Hepatitis B Virus Infection Predicts Extrahepatic Metastasis After Hepatic Resection in Patients With Large Hepatocellular Carcinoma

  • Hepatic and Pancreatic Tumors
  • Original Papers
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although extrahepatic metastasis occurs rarely after hepatic resection for hepatocellular carcinoma (HCC), the prognosis of these patients is extremely poor. Predictors of extrahepatic metastasis have not been fully investigated.

Methods

To identify predictors of extrahepatic metastasis after resection, we retrospectively investigated 77 patients with HCC tumors >50 mm in diameter who underwent hepatic resection. We investigated correlations between postoperative extrahepatic metastasis and clinicopathologic factors as well as extrahepatic metastasis-free survival rate by log rank test and predictors of extrahepatic metastasis by univariate and multivariate logistic regression models.

Results

Hepatitis B surface antigen (HBs-Ag) was found in 25 (32.5%) of 77 patients, and extrahepatic metastasis occurred in 26 (33.8%). Patients with extrahepatic metastasis showed better liver function and a high occurrence of HBs-Ag positivity than those without. The 5-year extrahepatic metastasis-free survival rate was worse in patients with HBs-Ag positivity, larger tumors (≥70 mm), higher alfa-fetoprotein level (≥300 ng/mL), and lower indocyanine green retention rate at 15 minutes (ICGR15) (<15%) than in those without. By univariate logistic regression analysis, HBs-Ag positivity, larger HCC tumor (≥70 mm), lower ICGR15 (<15%), and lower preoperative lymphocyte count (<1000/mm3) were predictors of extrahepatic metastasis (P < .1). By multivariate analysis, HBs-Ag positivity was an independent predictor of postoperative extrahepatic metastasis (P = .04).

Conclusions

In patients positive for HBs-Ag, radiologic examination of extrahepatic organs should be performed as a part of the postoperative surveillance. Hepatitis B virus infection may promote establishment of extrahepatic metastasis.

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Authors and Affiliations

  1. Department of Surgery, National Hospital Organization Miyazaki Hospital, Miyazaki, 889-1301, Japan

    Atsushi Sasaki MD

  2. Department of Surgery I, Oita University Faculty of Medicine, Oita, 879-5593, Japan

    Atsushi Sasaki MD, Seiichiro Kai MD, Yuichi Endo MD, Kentaro Iwaki MD, Hiroki Uchida MD, Kohei Shibata MD, Masayuki Ohta MD & Seigo Kitano MD

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  1. Atsushi Sasaki MD
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  2. Seiichiro Kai MD
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  3. Yuichi Endo MD
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  4. Kentaro Iwaki MD
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  5. Hiroki Uchida MD
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  6. Kohei Shibata MD
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  7. Masayuki Ohta MD
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  8. Seigo Kitano MD
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Correspondence to Atsushi Sasaki MD.

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Sasaki, A., Kai, S., Endo, Y. et al. Hepatitis B Virus Infection Predicts Extrahepatic Metastasis After Hepatic Resection in Patients With Large Hepatocellular Carcinoma. Ann Surg Oncol 14, 3181–3187 (2007). https://doi.org/10.1245/s10434-007-9570-x

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  • DOI: https://doi.org/10.1245/s10434-007-9570-x

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