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High Levels of Hepatitis B Surface Antigen are Associated with Poorer Survival and Early Recurrence of Hepatocellular Carcinoma in Patients with Low Hepatitis B Viral Loads

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Recurrence is a disastrous outcome in patients with hepatitis-related hepatocellular carcinoma (HCC) who have undergone curative resection, and little is known about whether high levels of hepatitis B surface antigen (HBsAg) increase the risk of HCC recurrence.

Patients and Methods

This retrospective study included 1,360 HBsAg-positive postoperative HCC patients with hepatitis B viral (HBV) DNA levels < 2000 IU/mL, including 298 patients in a training cohort and 1,062 patients in a validation cohort. The prognostic value of the HBsAg level was evaluated using Cox regression and Kaplan–Meier analyses.

Results

We demonstrated that 1,000 IU/mL, but not 10 or 100 IU/mL, was a meaningful cutoff level for significantly discriminating these patients into an HBsAgLow group and an HBsAgHigh group based on correlations between the HBsAg level and liver cirrhosis (p = 0.028), tumor size (p = 0.039), and hepatitis B e antigen level (p < 0.001). The postoperative 1-, 3-, and 5-year overall survival (OS) rates of HCC patients in the HBsAgLow group were significantly higher than those of HCC patients in the HBsAgHigh group. Accordingly, the 5-year recurrence-free survival (RFS) rates of patients in the HBsAgLow group were markedly higher than those of HCC patients in the HBsAgHigh group. The HBsAg level was a prognostic indicator for OS (p = 0.014) and RFS (p = 0.01).

Conclusion

HBsAg level is correlated with more aggressive tumor behavior and serves as a prognostic indicator in patients with surgically resected HCC with low HBV load.

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Acknowledgment

This work was supported by Grants from the National Natural Science Foundation of China (No. 81272389 and 81030038), National Key Sci-Tech Project (2012ZX10002011-002), and Scholarship Award for Excellent Doctoral Student granted by the Ministry of Education (JFF152005).

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Corresponding authors

Correspondence to Jia Fan MD, PhD or Ying-Hong Shi MD, PhD.

Additional information

Wei-Ren Liu and Meng-Xin Tian contributed equally to this work.

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Liu, WR., Tian, MX., Jin, L. et al. High Levels of Hepatitis B Surface Antigen are Associated with Poorer Survival and Early Recurrence of Hepatocellular Carcinoma in Patients with Low Hepatitis B Viral Loads. Ann Surg Oncol 22, 843–850 (2015). https://doi.org/10.1245/s10434-014-4043-5

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  • DOI: https://doi.org/10.1245/s10434-014-4043-5

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