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Impact of postoperative hepatitis B virus reactivation in hepatocellular carcinoma patients who formerly had naturally suppressed virus

 Jung Il Lee  ;  Ja Kyung Kim  ;  Hye Young Chang  ;  Jin-Woo Lee  ;  Joon Mee Kim  ;  Hyun Jung Chung  ;  Young Soo Kim  ;  Kwan Sik Lee 
 Journal of Gastroenterology and Hepatology, Vol.29(5) : 1019-1027, 2014 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/surgery ; Carcinoma, Hepatocellular/virology* ; DNA, Circular/metabolism ; DNA, Viral/blood ; DNA, Viral/metabolism ; Female ; Hepatectomy ; Hepatitis B virus/genetics ; Hepatitis B virus/physiology* ; Humans ; Liver/metabolism ; Liver Neoplasms/surgery ; Liver Neoplasms/virology* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/virology ; Postoperative Period ; Virus Replication*
covalently closed circular DNA ; hepatitis B virus ; hepatocellular carcinoma ; prognosis ; virus replication
BACKGROUND AND AIM: Hepatitis B virus (HBV) replication detected before the resection of hepatocellular carcinoma (HCC) is to be controlled by antiviral agents. However, management strategy for patients with preoperatively undetectable HBV DNA without antiviral therapy is not clearly delineated. This study investigated viral reactivation after the liver resection in non-replicating HBV DNA-related HCC patients and its impact on the surgical outcome. METHODS: From 198 patients that underwent liver resection due to HBV-related HCC, 101 patients who had serially checked serum HBV DNA were analyzed. RESULTS: From 101 patients, 33 patients had baseline undetectable HBV DNA. Eleven patients (11/33, 33.3%) had viral replication after the liver resection. The postoperative viral reactivation (HR: 2.144; 95% CI: 1.122-4.097; P = 0.021), along with the existence of satellite nodules (HR: 3.034; 95% CI: 1.1.376-6.689; P = 0.006), existence of microvascular invasion (HR: 2.479; 95% CI: 1.303-4.718; P = 0.006), and HBeAg positivity (HR: 2.059; 95% CI: 1.155-3.670; P = 0.014) predicted recurrence after the surgery. Quantification of intrahepatic total and covalently closed circular DNA (cccDNA) was done in 14 patients whose baseline serum HBV DNA was undetectable without the use of antiviral agent. Amount of intrahepatic cccDNA expressed as copies/hepatocyte in patients with postoperative viral reactivation showed significantly higher than those in patients with sustained negative serum HBV DNA (P = 0.010). CONCLUSIONS: This study shows that naturally suppressed preoperative HBV without application of antiviral agent does not ensure undetectable serum HBV after the surgery, and postoperative viral reactivation might be associated with HCC recurrence.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Lee, Jung Il(이정일) ORCID logo https://orcid.org/0000-0002-0142-1398
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