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HBV and HCC: Comment on “Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinomain Patients With Cirrhosis: A Western Dual-Center Experience”

HBV and HCC: Comment on “Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy... The surgical management of HCC in the cirrhotic patient remains a tremendous challenge, despite an array of treatment options including hepatic resection, ablative techniques, and liver transplantation. Although not without controversy, most regard resection as the treatment option of choice for solitary, relatively small, resectable lesions in those cirrhotic patients with preserved liver function. Unfortunately, HCC recurrence is common and often affects overall survival. Thus, it is important to determine those factors that predict HCC recurrence for 2 reasons: first, to identify that population most likely to benefit from traditional resection and, second, to direct those at greatest risk for recurrence toward alternate modalities. In this article, the authors present their experience with resection for HCC in 204 patients. Although retrospective in nature, the patients included are fairly homogeneous: all were cirrhotic, with compensated hepatic function and relatively early HCC. By focusing on disease-free survival, the authors avoid the confounding effect that hepatic disease progression has on overall survival. Through a simple but thorough analysis, the authors demonstrate that a diagnosis of HBV infection negatively affects disease-free survival. As referenced, this result has been previously reported.1,2 Two observations are difficult to explain. First, HBcAb positivity, even without evidence of active viral replication, was an independent predictor of HCC recurrence. Second, HCV infection was not associated with HCC recurrence. The authors offer an explanation for the former observation but not the latter. Nonetheless, the independent association of HBV infection with HCC recurrence has important implications for the role of antiviral therapy after resection and for the consideration of adjuvant or alternative therapy (ie, liver transplantation) for patients at greatest risk of HCC recurrence. Correspondence: Dr Levi, Department of Surgery, University of Miami Miller School of Medicine, Highland Professional Building, 1801 NW Ninth Ave, Ste 327, Miami, FL 33136 (dlevi@med.miami.edu). Financial Disclosure: None reported. References 1. Sun HCZhang WQin LX et al. Positive serum hepatitis e antigen is associated with higher risk of early recurrence and poorer survival in patients after curative resection of hepatitis B-related hepatocellular carcinoma. J Hepatol 2007;47 (5) 684- 690PubMedGoogle ScholarCrossref 2. Kubo SHirohashi KYamazaki O et al. Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B. World J Surg 2002;26 (5) 555- 560PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

HBV and HCC: Comment on “Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinomain Patients With Cirrhosis: A Western Dual-Center Experience”

Archives of Surgery , Volume 144 (10) – Oct 19, 2009

HBV and HCC: Comment on “Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinomain Patients With Cirrhosis: A Western Dual-Center Experience”

Abstract

The surgical management of HCC in the cirrhotic patient remains a tremendous challenge, despite an array of treatment options including hepatic resection, ablative techniques, and liver transplantation. Although not without controversy, most regard resection as the treatment option of choice for solitary, relatively small, resectable lesions in those cirrhotic patients with preserved liver function. Unfortunately, HCC recurrence is common and often affects overall survival. Thus, it is...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2009.98
Publisher site
See Article on Publisher Site

Abstract

The surgical management of HCC in the cirrhotic patient remains a tremendous challenge, despite an array of treatment options including hepatic resection, ablative techniques, and liver transplantation. Although not without controversy, most regard resection as the treatment option of choice for solitary, relatively small, resectable lesions in those cirrhotic patients with preserved liver function. Unfortunately, HCC recurrence is common and often affects overall survival. Thus, it is important to determine those factors that predict HCC recurrence for 2 reasons: first, to identify that population most likely to benefit from traditional resection and, second, to direct those at greatest risk for recurrence toward alternate modalities. In this article, the authors present their experience with resection for HCC in 204 patients. Although retrospective in nature, the patients included are fairly homogeneous: all were cirrhotic, with compensated hepatic function and relatively early HCC. By focusing on disease-free survival, the authors avoid the confounding effect that hepatic disease progression has on overall survival. Through a simple but thorough analysis, the authors demonstrate that a diagnosis of HBV infection negatively affects disease-free survival. As referenced, this result has been previously reported.1,2 Two observations are difficult to explain. First, HBcAb positivity, even without evidence of active viral replication, was an independent predictor of HCC recurrence. Second, HCV infection was not associated with HCC recurrence. The authors offer an explanation for the former observation but not the latter. Nonetheless, the independent association of HBV infection with HCC recurrence has important implications for the role of antiviral therapy after resection and for the consideration of adjuvant or alternative therapy (ie, liver transplantation) for patients at greatest risk of HCC recurrence. Correspondence: Dr Levi, Department of Surgery, University of Miami Miller School of Medicine, Highland Professional Building, 1801 NW Ninth Ave, Ste 327, Miami, FL 33136 (dlevi@med.miami.edu). Financial Disclosure: None reported. References 1. Sun HCZhang WQin LX et al. Positive serum hepatitis e antigen is associated with higher risk of early recurrence and poorer survival in patients after curative resection of hepatitis B-related hepatocellular carcinoma. J Hepatol 2007;47 (5) 684- 690PubMedGoogle ScholarCrossref 2. Kubo SHirohashi KYamazaki O et al. Effect of the presence of hepatitis B e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B. World J Surg 2002;26 (5) 555- 560PubMedGoogle ScholarCrossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 19, 2009

Keywords: liver cirrhosis,hepatitis b,hepatic resection,hepatitis b virus,hepatitis b virus measurement

References