Effects of Hepatitis B Virus Load on Hepatectomy

Background: To investigate the impact of preoperative hepatitis B virus status, as well as postoperative antiviral therapy, on the risk of recurrence-free survival (RFS), overall survival (OS) after curative resection of hepatitis B virus-related hepatocellular carcinoma (HCC) within milan criteria (MC). Patients and methods: A retrospective studies regarding hepatitis B virus-related HCC patients within MC undergoing curative resection from 2007 to 2012 were analysed. Two groups were compared according to preoperative virus status (using 1,000 copies/ml of hepatitis B virus DNA level as cut-off value). Prognostic factors for OS and RFS were evaluated. Additionally, subgroup analysis was conducted in patients with positive hepatitis B virus-DNA (HBV-DNA) to investigate prediction of postoperative antiviral therapy on the long-term prognosis. Results: Patients with positive HBV-DNA had lower OS rates (1 year, 3 year, and 5 year: 91.7%, 77.4%, and 69.6%, respectively) as compared to those with negative HBV-DNA (1-year, 3-year, and 5-year: 95.0%, 82.3%, and 74.6%, respectively) (P=0.041). There were significant differences in RFS rates of the positive vs. negative HBVDNA group (1-year, 3-year, 5-year: 70.8%, 49.3%, 32.8% vs. 73.7%, 53.7%, 41.8%, respectively) (P=0.032). Multivariate analysis revealed that preoperative positive HBV-DNA was an independent risk factor affecting OS (P<0.001) and RFS (P<0.001). The subgroup analysis revealed that postoperative antiviral therapy independently improved OS and RFS (P<0.001). Conclusions: Preoperative positive HBV-DNA of Hepatitis B virus-related HCC patients within MC led to a poor overall and recurrence-free survival than those with negative HBV-DNA after curative resection. To prevent postoperative recurrence, antiviral therapy should be initiated if HBV-DNA ≥ 1,000 copies/ml.