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Clinical Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma Patients with Undetectable Serum HBV DNA Levels
Jong-In Chang 1 , Dong Hyun Sinn 2 , Hyun Cho 3 , Seonwoo Kim 4 , Wonseok Kang 1 , Geum-Youn Gwak 1 , Yong-Han Paik 1 , Moon Seok Choi 1 , Joon Hyeok Lee 1 , Kwang Cheol Koh 1 , Seung Woon Paik 1
Affiliations
Affiliations
1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
2
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. [email protected].
3
Samsung Medical Center, Research Institute for Future Medicine, Seoul, Korea.
4
Statistics and Data Center, Samsung Medical Center, Seoul, Korea.
PMID: 34800218 DOI: 10.1007/s10620-021-07312-8
Abstract
Background and aims: Some hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients show undetectable serum HBV DNA levels at HCC diagnosis. The risk of HBV reactivation and its impact on clinical outcomes are not well-unknown.
Methods: This retrospective cohort study included a total of 985 HBV-related HCC patients with undetectable serum HBV DNA levels (< 12 IU/mL) at HCC diagnosis (112 were antiviral treatment (AVT)-naïve; 873 were receiving AVT). Incidence and risk factors for HBV reactivation (re-detection of HBV DNA in serum) during follow-up, as well as its association to overall survival, were assessed.
Results: During a median of 33.4 months of follow-up (range: 0.2-124.2 months), HBV reactivation was observed in 279 patients. HBV reactivation rate was significantly lower for patients receiving AVT than AVT-naïve patients (three-year cumulative incidence rate: 27.3% versus 56.0%; P < 0.001). In multivariable-adjusted analysis, the risk of HBV reactivation was lower for those receiving AVT compared to AVT-naïve patients (adjusted hazard ratio: 0.39, 95% confidence interval: 0.29-0.54). Overall survival was significantly lower for those experiencing HBV reactivation than those who did not (71.5% and 85.7% at five-year) and was associated with higher risk of overall mortality (adjusted hazard ratio: 5.15, 95% confidence interval: 3.60-7.38).
Conclusion: More than half of AVT-naïve patients experienced HBV reactivation within three years, which was associated with increased risk of overall mortality. The risk of HBV reactivation was lower for those receiving AVT, suggesting that prompt AVT needs to be considered for AVT naïve HBV-related HCC patients with undetectable HBV DNA levels.
Keywords: Antiviral therapy; HBV flare; Hepatitis B virus; Hepatocellular carcinoma.
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature |
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