Hepatitis B Surface Antigen Predicts Hepatocellular Carcinoma Return

Hepatitis B virus activity marker may predict prognosis after liver cancer surgery

medwireNews: Monitoring hepatitis B surface Antigen (HBsAg) may improve identification of patients at risk of recurrent hepatocellular carcinoma (HCC) after partial hepatectomy, research suggests.

Over a median follow-up of 60 months, 5-year disease-free survival was achieved by 46.1% of patients with an HBsAg level below 1000 IU/mL compared with just 34.1% of those with a HBsAg level on or above that threshold.

Overall survival also differed significantly, at 57.5% and 48.8%, respectively, report Wei-ping Zhou, from Eastern Hepatobiliary Surgery Hospital in Shanghai, China, and co-workers.

Thus, of 1062 patients with a low hepatitis B virus (HBV) DNA level who did not receive adjuvant therapy, an HBsAg level of 1000 IU/mL or above was a significant and independent predictor of HCC recurrence, with a hazard ratio (HR) of 1.23 in multivariate analysis.

Other significant predictors of HCC recurrence were seropositivity for the HBV activity marker HB e antigen (HBeAg, HR=1.30), a tumour diameter greater than 5 cm (HR=1.34), a surgical margin of less than 1 cm (HR=1.22), the presence of satellite nodules (HR=2.65) or portal vein tumour thrombus (HR=6.06) and receipt of blood transfusion (HR=1.45).

Further analysis indicated that a high HBsAg level was significantly associated with the risk of late HCC recurrence, defined as more than 2 years after surgery (HR=1.93), but did not independently predict the likelihood of earlier recurrence.

Nevertheless, in receiver operating characteristic curve analysis, HBsAg level was better at predicting HCC recurrence than HBeAg seropositivity, the team reports in JAMA Surgery.

The researchers explain that while a low HBV DNA level does not necessarily indicate true virus inactivity, low HBsAg in patients with low HBV DNA levels is likely a sign of adequate immune control against HBV, and therefore being at minimal risk of HCC recurrence.

“Quantitative measurement of HBsAg level can be used as a new Prognostic factor of HCC recurrence after partial hepatectomy in patients with a low HBV DNA level”, they advise.

“A future study should examine whether patients with low HBV DNA but high HBsAg levels should receive antiviral treatment”, they recommend.


Huang G, Lau W, Zhou W-p, et al. Prediction of hepatocellular carcinoma recurrence in patients with low hepatitis B virus DNA levels and high preoperatve hepatitis B surface antigen levels. JAMA Surg 2014; Advance online publication 2 April. doi:10.1001/jamasurg.2013.4648

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