Impact of Surveillance in Chronic Hepatitis B Patients on Long-Term Outcomes After Curative Liver Resection for Hepatocellular Carcinoma

Statistical Cure After Hepatectomy for Hepatitis B Virus-Associated Hepatocellular Carcinoma: A Risk-Stratification Model

BACKGROUND

Statistical cure, defined as achieving life expectancy comparable with that of disease-free individuals, has not been specifically investigated in hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC), which accounts for more than 50% of the global HCC burden. This study aimed to develop a cure model for HBV-HCC after hepatectomy using matched HBV carriers and the general population as reference groups.

METHODS

From a Chinese multicenter database, HBV-HCC patients who underwent curative-intent hepatectomy were retrospectively reviewed. Independent prognostic factors were identified through Cox regression. A spline-based cure model was applied using two reference populations: matched Chinese HBV carriers (from Shanghai Center for Disease Control and Prevention) and the general population (from the National Bureau of Statistics).

RESULTS

The study analyzed 740 HBV-HCC patients. The following eight independent risk factors were identified: preoperative high viral load (hazard ratio [HR] 1.27), Child-Pugh grade (HR 1.21 and 1.43), multiple tumors (HR 1.70), tumor size greater than 5.0 cm (HR 1.47), macrovascular invasion (HR 3.33), microvascular invasion (HR 1.25), intraoperative blood transfusion (HR 1.21), and postoperative HBV reactivation (HR 1.89). The overall cure probability was 21.2% versus that for HBV carriers and 11.1% versus that for the general population. Risk stratification identified distinct groups relative to HBV carriers. Low risk (64.2%) showed an initial cure rate of 30.3% and achieved a 95% cure probability by 8.6 years, whereas high risk (10.5%) showed negligible cure probability.

CONCLUSIONS

This first HBV-HCC-specific cure model demonstrated that statistical cure is achievable for a subset of patients after hepatectomy. Risk stratification identifies patients with varying cure probabilities, providing valuable guidance for personalized treatment strategies and surveillance protocols.

Differences in complications between hepatitis B-related cirrhosis and alcohol-related cirrhosis

OBJECTIVES

This study aimed to investigate the differences in complications between hepatitis B virus (HBV)-related and alcohol-related cirrhoses.

METHODS

Medical records of patients with HBV-related and alcohol-related cirrhoses treated from January 2014 to January 2021 were, retrospectively, reviewed. The unadjusted rate and adjusted risk of cirrhotic complications between the two groups were assessed.

RESULTS

The rates of hepatocellular carcinoma (HCC) and hypersplenism were higher in HBV-related cirrhosis (both P < 0.05), whereas the rates of hepatic encephalopathy (HE) and acute-on-chronic liver failure (ACLF) were higher in alcohol-related cirrhosis (both P < 0.05). After adjusting for potential confounders, HBV-related cirrhotic patients had higher risks of HCC (odds ratio [OR] = 34.06, 95% confidence interval [CI]: 4.61-251.77, P = 0.001) and hypersplenism (OR = 2.29, 95% CI: 1.18-4.42, P = 0.014), whereas alcohol-related cirrhotic patients had higher risks of HE (OR = 0.22, 95% CI: 0.06-0.73, P = 0.013) and ACLF (OR = 0.30, 95% CI: 0.14-0.73, P = 0.020).

CONCLUSION

Cirrhotic patients with different etiologies had different types of complications: HBV-related cirrhotic patients exhibited increased risks of HCC and hypersplenism and alcohol-related cirrhotic patients more readily developing HE and ACLF.

Transcatheter arterial chemoembolization combined with microwave ablation for treatment of early liver cancer: Efficacy and prognostic factors for progression-free survival

BACKGROUND

Transcatheter arterial chemoembolization (TACE) and microwave ablation (MWA) are the main methods for the treatment of liver cancer worldwide. TACE can block the blood vessels of liver cancer and clearly show the area where the tumor is located. The solid tumor can be completely ablated by MWA. However, postoperative recurrence is still a difficult problem to solve.

AIM

To assess the efficacy of TACE combined with MWA in the treatment of liver cancer at early Barcelona clinic liver cancer (BCLC) stage and identify the factors affecting recurrence.

METHODS

A retrospective analysis was performed on 42 patients with post-hepatitis B virus (HBV) liver cancer at early BCLC stage who underwent TACE combined with MWA at our hospital from February 2016 to November 2017. After surgery, the efficacy was evaluated and complications were recorded. The patients were followed at 1 mo, 2 mo, 3, mo 6 mo, 12 mo, and 18 mo after WMA for CT, alpha fetoprotein (AFP), liver function, or hepatic angiography, and the time to recurrence was recorded.

RESULTS

By the last follow-up, the total effective rate was 61.5% and the lesion control rate was 84.2%. The median progression-free-survival (PFS) was 7.3 mo (range, 2.3-34). Univariate analysis showed that female patients had a PFS of 14 mo and male patients had a PFS of 11 mo. Patients ≥ 60 years of age had a PFS of 3.8 mo, and patients < 60 years of age had a PFS of 8.9 mo. The PFS of patients with tumor < 3 cm, 3 to 5 cm, and 5-10 cm was 14, 10.5, and 11.2 mo, respectively. The PFS of patients with single tumor and multiple tumors was 13.6 and 4 mo, respectively. The PFS of patients with Child A and Child B disease was 20.8 mo vs 11.2 mo. The PFS of BCLC stage 0 patients and BCLC stage A patients was 15.5 mo vs 11.2 mo. HBV-DNA positive patients had a PFS of 11.2 mo, and HBV-DNA negative patients had a PFS of 13.3 mo. The median PFS of HBeAg-positive cases was 11.2 mo, and that of HBeAg-negative cases was 13.3 mo. Univariate analysis showed that gender, age, Child grade, number of tumors, and BCLC stage were significantly correlated with PFS, but tumor size, preoperative HBV-DNA, and HBeAg status did not. In multivariate analysis, Child grade, BCLC stage, and gender were identified to be independent risk factors for PFS in early BCLC stage liver cancer patients undergoing sequential treatment of TACE and MWA (P < 0.05).

CONCLUSION

TACE combined with MWA is safe and effective in the treatment of early BCLC stage liver cancer. Child grade, BCLC stage, and gender may affect postoperative recurrence.