Hepatitis B virus DNA levels and overall survival in hepatitis B‐related hepatocellular carcinoma patients with low‐level viremia

医学 危险系数 肝细胞癌 乙型肝炎病毒 内科学 置信区间 病毒血症 乙型肝炎 胃肠病学 免疫学 病毒
作者
Tae‐Se Kim,Dong Hyun Sinn,Wonseok Kang,Geum‐Youn Gwak,Yong‐Han Paik,Moon Seok Choi,Joon Hyeok Lee,Kwang Cheol Koh,Seung Woon Paik
出处
期刊:Journal of Gastroenterology and Hepatology [Wiley]
卷期号:34 (11): 2028-2035 被引量:22
标识
DOI:10.1111/jgh.14750
摘要

Abstract Background and Aim Clinical course of hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) patients presenting with low‐level viremia (LLV) is unclear. Methods A total of 565 HBV‐related HCC patients with LLV (detectable but HBV DNA ≤ 2000 IU/mL) at the time of HCC diagnosis were analyzed. Based on patterns of HBV DNA levels during follow‐up, patients were categorized into three groups: maintained virologic remission (MVR), LLV, and flare. Overall survival was compared between those three groups. Results During a median 4.5 years of follow‐up, 33% showed MVR, 39% showed LLV, and 28% experienced flare. The overall survival differed between MVR, LLV, and flare groups (5‐year overall survival: 74.3%, 67.3%, and 61.7%, respectively, 0.015). The patterns of HBV DNA levels were independent factors associated with overall survival, along with age, antiviral treatment, Barcelona clinic liver cancer stage, and initial treatment modality. Flare group showed increased risk of mortality (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.15–2.55) compared with MVR group, while the risk was statistically marginal for the LLV group (adjusted HR 1.39, 95% CI 0.95–2.04). During follow‐up, 183 patients (32.4%) newly started antiviral therapy (AVT) at LLV. Flare risk was significantly lower among patients who started AVT at LLV compared with those who did not (adjusted HR 0.26, 95% CI 0.17–0.38). Conclusions Among HBV‐related HCC patients with LLV, flare was frequent during follow‐up and was associated with poorer overall survival compared with MVR group. Prospective studies that address whether inducing MVR by early AVT improves patient outcome are warranted.
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