Association Between Viral Replication Activity and Postoperative Recurrence of <scp>HBV</scp>‐Related Hepatocellular Carcinoma
Subin Heo, Jiwon Yang, Jeayeon Park, Rex Wan‐Hin Hui, Byeong Geun Song, In Hye Song, Young‐In Yoon, Tan To Cheung, Sung Won Chung, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young‐Suk Lim, Han Chu Lee, Wai‐Kay Seto, Jeong‐Hoon Lee, Won‐Mook Choi
Abstract
ABSTRACT Background Baseline viral replication activity influences the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B virus (HBV) infection. Aims To evaluate the impact of baseline viral replication activity on recurrence in HBV‐related HCC after curative resection. Methods A multinational retrospective cohort of 2384 patients with very early or early‐stage HBV‐related HCC who consecutively underwent curative resection and received antiviral therapy (AVT) between 2010 and 2018 was analysed. Patients were categorised into ongoing‐AVT (previously on AVT with viral suppression) and initiation‐AVT (initiated AVT at the time of resection) groups. HCC recurrence was compared between these two groups based on baseline viral replication activity. Results During a median follow‐up of 4.9 years, 1188 (49.8%) patients developed recurrence. Multivariable analysis showed similar recurrence risk between the ongoing‐AVT and initiation‐AVT groups (HR, 1.09; 95% CI, 0.96–1.24). However, in cirrhotic patients, the initiation‐AVT group had a higher recurrence risk than the ongoing‐AVT group (HR, 1.22; 95% CI, 1.02–1.45) but not in non‐cirrhotic patients (HR, 0.90; 95% CI, 0.73–1.09). Intriguingly, in the non‐cirrhotic initiation‐AVT group, a parabolic association was observed between baseline HBV DNA levels and the risk of recurrence, with those having 5–6 log 10 IU/mL HBV DNA levels showing significantly higher recurrence risk compared to the ongoing‐AVT group (HR, 1.78; 95% CI, 1.32–2.42). Conclusions The association between HBV replication activity and the risk of HCC recurrence varied depending on cirrhosis, providing important insights for optimising the timing of AVT and post‐operative surveillance strategies.