手术切除后的病毒相关性肝细胞癌

StephenW

手术切除后的病毒相关性肝细胞癌

    孙佑†
    金智允†
    Young-Suk Lim
    韩升凤
    钟基崔
    显示脚注

发布时间：2022年5月25日DOI：https://doi.org/10.1016/j.jhep.2022.05.014
PlumX 指标

强调

    •
    HBsAg 血清学清除是否会影响肝切除术后晚期（≥2 年）HCC 复发的风险仍未得到解答。
    •
    对 2,520 名因 BCLC 0 或 A 的 HBV 相关 HCC 接受根治性肝切除术的韩国患者进行了分析。
    •
    肝切除术后 HBsAg 血清学清除与晚期（≥2 年）HCC 复发风险降低独立相关。

背景与目标
目前尚不清楚 HBsAg 血清学清除是否会影响肝切除术后肝细胞癌 (HCC) 复发的风险。我们旨在研究 HBsAg 血清学清除对治愈性肝切除术后 HCC 复发的影响，重点是晚期复发。
方法
本研究包括 2,520 名在 2000 年至 2017 年间在韩国巴塞罗那诊所肝癌 0 期或 A 期接受治愈性肝切除术的 HBV 相关 HCC 患者。重点关注晚期复发、复发或随访时间少于 2 次的患者年被排除在外。通过标志性分析（肝切除后 2 年、5 年和 8 年）、时间依赖性 Cox 和多状态模型评估 HBsAg 血清学清除对 HCC 复发的影响。
结果
患者平均年龄为 54.4 岁，75.7% 为男性。共有 891 名 (35.4%) 患者在切除后 3、5 和 10 年发生 HCC 复发，复发率分别为 11.2%、25.5% 和 46.8%。在切除术后 6.9 年的中位随访期间，172 名（6.8%）患者实现了 HBsAg 血清学清除。在 2 年、5 年和 8 年的标志性分析中（分别为 p = 0.04、p = 0.02 和 p = 0.03），与持续的 HBsAg 阳性相比，HBsAg 血清学清除与晚期 HCC 复发的风险较低相关。时间相关的多变量 Cox 建模（调整后的风险比 0.62；p = 0.005）。基于三态单向疾病-死亡模型，没有 HBsAg 血清学清除的患者比 HBsAg 血清学清除的患者更快地转变为 HCC 复发。
结论
在接受根治性肝切除术的韩国患者中，HBsAg 血清学清除与 HBV 相关 HCC 晚期复发风险降低相关。
总结
乙型肝炎病毒 (HBV) 感染是导致慢性肝病和肝细胞癌 (HCC) 的主要原因。已知抑制 HBV 复制可降低肝切除术后 HCC 复发的风险（一种用于治疗和在某些情况下治愈 HCC 的手术）。然而，特定 HBV 蛋白（乙型肝炎表面抗原或 HBsAg）的丢失是否对肝切除术后的复发有影响仍然未知。在此，我们表明 HBsAg 的消失与 HBV 相关 HCC 患者肝切除术后 HCC 晚期复发风险的降低有关。

StephenW

virus-related hepatocellular carcinoma after surgical resection

    Sun Yoo †
    Ji Yoon Kim †
    Young-Suk Lim
    Seungbong Han
    Jonggi Choi
    Show footnotes

Published:May 25, 2022DOI:https://doi.org/10.1016/j.jhep.2022.05.014
PlumX Metrics

Highlights

    •
    Whether HBsAg seroclearance affects the risk of late (≥2 years) HCC recurrence after liver resection remains unanswered.
    •
    2,520 consecutive Korean patients who underwent curative-intent liver resection for HBV-related HCC of BCLC 0 or A were analyzed.
    •
    HBsAg seroclearance after liver resection was independently associated with a reduced risk of late (≥2 years) HCC recurrence.

Background & Aims
It is unknown whether HBsAg seroclearance affects the risk of hepatocellular carcinoma (HCC) recurrence after liver resection. We aimed to investigate the impact of HBsAg seroclearance on the recurrence of HCC after curative liver resection, with a focus on late recurrence.
Methods
This study comprised 2,520 consecutive patients who received curative liver resection for HBV-related HCC of Barcelona Clinic Liver Cancer stage 0 or A in Korea between 2000 and 2017. To focus on late recurrence, patients with recurrence or a follow-up duration less than 2 years were excluded. The impact of HBsAg seroclearance on HCC recurrence was assessed by landmark analysis (2-, 5-and 8-year after liver resection), time-dependent Cox and multistate modeling.
Results
The mean patient age was 54.4 years and 75.7% were men. A total of 891 (35.4%) patients developed HCC recurrence at rates of 11.2%, 25.5%, and 46.8% at 3, 5, and 10 years after resection. HBsAg seroclearance was achieved in 172 (6.8%) patients during a median follow-up duration of 6.9 years after resection. HBsAg seroclearance, compared with persistent HBsAg positivity, was associated with a lower risk of late HCC recurrence in the 2-, 5-, and 8-year landmark analysis (p = 0.04, p = 0.02 and p = 0.03, respectively) and on time-dependent multivariable Cox modeling (adjusted hazard ratio 0.62; p = 0.005). Based on a 3-state unidirectional illness–death model, patients without HBsAg seroclearance transitioned to HCC recurrence more rapidly than patients who experienced HBsAg seroclearance.
Conclusions
HBsAg seroclearance is associated with a lower risk of late recurrence of HBV-related HCC among Korean patients who undergo curative liver resection.
Lay summary
Hepatitis B virus (HBV) infection is a leading cause of chronic liver disease and hepatocellular carcinoma (HCC). Suppression of HBV replication is known to lower the risk of HCC recurrence after liver resection (a procedure used to treat and in some cases cure HCC). However, whether the loss of a specific HBV protein (hepatitis B surface antigen or HBsAg) has an impact on recurrence after liver resection remains unknown. Herein, we show that loss of HBsAg is associated with a reduce risk of late recurrence of HCC after liver resection in patients with HBV-related HCC.