High Preoperative Hepatitis B Surface Antigen Level Predicts Hepatocellular Carcinoma Recurrence in Patients With Low HBV DNA
In a Chinese study reported in JAMA Surgery, Huang et al found that preoperative elevated hepatitis B virus (HBV) surface antigen (HBsAg) level is an independent risk factor for hepatocellular carcinoma recurrence and mortality in patients with low HBV DNA levels undergoing hepatic resection.
Disease-Free Survival and Overall Survival
The study was a retrospective analysis of 1,062 HBsAg-seropositive patients with low HBV DNA levels (< 200 IU/mL) who underwent partial hepatectomy for hepatocellular carcinoma. Median follow-up was 60 months. Risk of tumor recurrence increased with HBsAg levels ≥ 1,000 IU/mL. For patients with low (< 1000 IU/mL; n = 622) vs high (≥ 1,000 IU/mL, n = 440) HBsAg level, 5-year disease-free survival was 46.1% vs 34.1% (P = .002) and overall survival was 57.5% vs 48.8% (P = .004).
Independent Predictor of Recurrence and Survival
On multivariate analysis for recurrence including factors found to be significant on univariate analysis (HBV envelope antigen [HBeAg] seropositivity, HBsAg level, preoperative transarterial chemoembolization, tumor diameter, clamp time, operation time, blood loss, transfusion, surgical margin, satellite nodules, portal vein thrombus, and inflammation score), HBsAg level ≥ 1,000 IU/mL was an independent predictor of recurrence (HR = 1.23, P = .01). Other independent predictors were HBeAg seropositivity, tumor size > 5 cm, blood transfusion, surgical margin < 1.0 cm, presence of satellite nodules, and portal vein tumor thrombus. The area under the receiver operator characteristic curve was higher for HBsAg level than for HBeAg seropositivity (0.56 vs 0.53).
On multivariate analysis, high HBsAg level was also an independent predictor of overall survival (HR = 1.26, P = .01), along with HBeAg seropositivity, tumor size > 5 cm, surgical margin < 1.0 cm, presence of satellite nodules, portal vein tumor thrombus, inflammation score, and fibrosis score.
The investigators concluded, “A preoperative HBsAg level of 1,000 IU/mL or greater is an independent risk factor for hepatocellular carcinoma recurrence in patients with low HBV DNA levels.”
Wei-ping Zhou, MD, PhD, of Eastern Hepatobiliary Surgery Hospital, Shanghai, is the corresponding author for the JAMA Surgery article.
The study was supported by grants from the State Key Project on Infectious Diseases of China and contracts from the National Natural Science Foundation of China. The study authors reported no potential conflicts of interest.
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