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Posthepatectomy HBV Reactivation in Hepatitis B–Related Hepatocellular Carcinoma Influences Postoperative Survival in Patients With Preoperative Low HBV-DNA Levels

Huang, Gang MD*; Lai, Eric C. H. MBChB, MRCSEd, FRACS*,†; Lau, Wan Yee MD, FRCS, FACS, FRACS(Hon)*,†; Zhou, Wei-ping MD, PhD*; Shen, Feng MD*; Pan, Ze-ya MD*; Fu, Si-yuan MD*; Wu, Meng-chao MD*

doi: 10.1097/SLA.0b013e318262b218
Original Articles

Objective: This study aimed to clarify the incidence of hepatitis B virus (HBV) reactivation and its significance on long-term survival after partial hepatectomy in patients with HBV-related hepatocellular carcinoma (HCC), who had preoperative low HBV-DNA level of less than 2000 IU/mL.

Background: HBV reactivation is a frequent complication of systemic chemotherapy in hepatitis B surface antigen–positive patients. Surgery and anesthesia result in a generalized state of immunosuppression in the immediate postoperative period. Data on HBV reactivation and its significance after partial hepatectomy are unclear.

Patients and Methods: Consecutive patients from January 2006 to December 2007 were retrospectively studied.

Results: HBV reactivation happened in 19.1% of patients in 1 year. There were 28 patients whose HBV reactivation was detected after the diagnosis of HCC recurrence. On multivariate analysis, hepatitis B e antigen (HBeAg) positivity, preoperative HBV-DNA above the lower limit of quantification (≥200 IU/mL), Ishak inflammation score of greater than 3, preoperative transarterial chemoembolization (TACE), operation time of more than 180 minutes, blood transfusion, and without prophylactic antiviral therapy were significantly associated with an increased risk of HBV reactivation. HBV reactivation negatively influenced postoperative hepatic functions. The posthepatectomy liver failure rate in patients with HBV reactivation was significantly higher than in those without reactivation (11.8% vs 6.4%; P = 0.002). The 3-year disease-free survival (DFS) rate and overall survival (OS) rates after resection in patients with HBV reactivation were significantly lower than those without reactivation (34.1% vs 46.0%; P = 0.009, and 51.6% vs 67.2%; P < 0.001, respectively). HBeAg positivity, detectable preoperative HBV-DNA level, high Ishak inflammation score, preoperative TACE, long operation time, and blood transfusion were independent risk factors for HBV reactivation, whereas prophylactic antiviral therapy was a protective factor. HBV reactivation, HBeAg positivity, HBV-DNA level of 200 IU/mL or more, tumor diameter greater than 5 cm, presence of satellite nodules, presence of portal vein tumor thrombus, blood transfusion, and resection margin less than 1.0 cm were independent risk factors for DFS. A HBV-DNA level of 200 IU/mL or more, an Ishak fibrosis score of 4 or greater, a tumor diameter greater than 5 cm, the presence of satellite nodules, the presence of portal vein tumor thrombus, a resection margin less than 1.0 cm, no prophylactic antiviral therapy, and HBV reactivation were independent risk factors for OS.

Conclusions: HBV reactivation was common after partial hepatectomy for HBV-related HCC with a preoperative low HBV-DNA level of less than 2000 IU/mL. Routine prophylactic antiviral treatment should be given before partial hepatectomy.

Hepatitis B virus (HBV) reactivation occurred in 19.1% of patients with a preoperative low HBV-DNA level of less than 2000 IU/mL in 1 year after partial hepatectomy for HBV-related hepatocellular carcinoma. Routine prophylactic antiviral treatment should be given to these patients before partial hepatectomy.

*Eastern Hepatobiliary Surgery Hospital, Shanghai

Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China.

Reprints: Wei-ping Zhou, MD, PhD, Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, People's Republic of China. E-mail: EHPHWP@126.com.

Disclosure: This work was supported by the Chinese Key Project for Infectious Diseases grants 2008ZX10002-018 and 2008ZX10002-025 and Science Fund for Creative Research Groups, NSFC, People's Republic of China, grant 30921006.

© 2013 Lippincott Williams & Wilkins, Inc.