Early and Late Recurrence of Hepatitis B Virus-Associated Hepatocellular Carcinoma

The oncologist

article

Ming-Da Wang¹  Timothy M. Pawlik²  Wan Yee Lau¹  Feng Shen¹  Tian Yang¹  Chao Li¹  Lei Liang¹  Hao Xing¹  Li-Yang Sun¹  Bing Quan¹  Han Wu¹  Xin-Fei Xu¹  Meng-Chao Wu¹ 

[1] Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital;Department of Surgery, Ohio State University, Wexner Medical Center;Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital;Department of Clinical Medicine, Second Military Medical University (Navy Medical University)

关键词: Hepatocellular carcinoma;    Resection;    Hepatitis B;    Survival;    Recurrence;   

DOI  :  10.1634/theoncologist.2019-0944

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background Survival after liver resection of hepatocellular carcinoma (HCC) remains poor because of a high incidence of recurrence. We sought to investigate risk factors, patterns, and long-term prognosis among patients with early and late recurrence after liver resection for hepatitis B virus (HBV)–associated HCC. Methods Data of consecutive patients undergoing curative resection for HBV-associated HCC were analyzed. According to the time to recurrence after surgery, recurrence was divided into early (≤2 years) and late recurrence (>2 years). Characteristics, patterns of initial recurrence, and postrecurrence survival (PRS) were compared between patients with early and late recurrence. Risk factors of early and late recurrence and predictors of PRS were identified by univariable and multivariable Cox regression analyses. Results Among 894 patients, 322 (36.0%) and 282 (31.5%) developed early and late recurrence, respectively. On multivariable analyses, preoperative HBV-DNA >10 4 copies/mL was associated with both early and late recurrence, whereas postoperative no/irregular antiviral therapy was associated with late recurrence. Compared with patients with late recurrence, patients with early recurrence had a lower proportion of intrahepatic-only recurrence (72.0% vs. 91.1%, p  < .001), as well as a lower chance of receiving potentially curative treatments for recurrence (33.9% vs. 50.7%, p  < .001) and a worse median PRS (19.1 vs. 37.5 months, p  < .001). Multivariable analysis demonstrated that early recurrence was independently associated with worse PRS (hazard ratio, 1.361; 95% confidence interval, 1.094–1.692; p = .006). Conclusion Although risk factors associated with early recurrence and late recurrence were different, a high preoperative HBV-DNA load was an independent hepatitis-related risk for both early and late recurrence. Early recurrence was associated with worse postrecurrence survival among patients with recurrence. Implications for Practice Liver resection is the main curative treatment for hepatocellular carcinoma (HCC), but postoperative survival remains poor because of high recurrence rates. This study investigated the risk factors and patterns of early and late recurrence and found that a high preoperative hepatitis B virus (HBV) DNA load was an independent hepatitis-related risk factor for both. Early recurrence was also independently associated with worse postrecurrence survival. These data may provide insights into different biological origin and behavior of early versus late recurrence after resection for HBV-associated HCC, which could be helpful to make individualized treatment decision for recurrent HCC, as well as strategies for surveillance recurrence after resection.

【 授权许可】

CC BY|CC BY-NC