Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2018; 6(8): 192-199
Published online Aug 16, 2018. doi: 10.12998/wjcc.v6.i8.192
Negative impact of hepatitis B surface seroclearance on prognosis of hepatitis B-related primary liver cancer
Cheng Lou, Tong Bai, Le-Wei Bi, Ying-Tang Gao, Zhi Du
Cheng Lou, Tong Bai, Zhi Du, Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Tianjin 300170, China
Cheng Lou, Ying-Tang Gao, Zhi Du, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
Cheng Lou, Ying-Tang Gao, Zhi Du, Tianjin Key Laboratory of Artificial Cell, Tianjin 300170, China
Cheng Lou, Ying-Tang Gao, Zhi Du, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China
Le-Wei Bi, the Graduate School of Tianjin Medical University, Tianjin 300070, China
Author contributions: Lou C and Du Z designed research; Lou C, Du Z, Bai T and Bi LW treated patients and collected material and clinical data; Gao YT collected and sorted material and clinical data; Lou C and Bi LW performed the assays and analyzed data; Lou C wrote the paper.
Supported by Tianjin Health Industry Key Project, No. 15KG113; Tianjin Science Foundation of China, No. 17JCYBJC26100.
Institutional review board statement: This study was approved by the Institutional Review Board of Third Central Hospital of Tianjin (Shu-ye Liu, China).
Informed consent statement: Informed consent was obtained.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhi Du, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary Surgery, Third Central Hospital of Tianjin, Hedong District, Jintang Road No. 83, Tianjin 300170, China. zhi-du@163.com
Telephone: +86-22-84112468
Received: May 15, 2018
Peer-review started: May 15, 2018
First decision: June 4, 2018
Revised: June 6, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: August 16, 2018
Processing time: 93 Days and 6.9 Hours
Abstract
AIM

To assess the impact of hepatitis B surface (HBsAg) seroclearance on survival outcomes in hepatitis B-related primary liver cancer.

METHODS

Information from patients with hepatitis B-related liver cancer admitted in our hospital from 2008-2017 was retrieved. Cases diagnosed with HBsAg (-) and HBcAb (+) liver cancer were included in the HBsAg seroclearance (SC) group. HBsAg (+) liver cancer patients strictly matched for liver cancer stage (AJCC staging system, 8th edition), Child-Pugh score, and first diagnosis/treatment method (surgery, ablation and TACE) were assigned to the HBsAg non-seroclearance (NSC) group. Then, clinical, pathological and survival data in both groups were assessed.

RESULTS

The SC and NSC groups comprised of 72 and 216 patients, respectively. Patient age (P < 0.001) and platelet count (P = 0.001) in the SC group were significantly higher than those of the NSC group. SC group patients who underwent surgery had more intrahepatic cholangiocarcinoma (ICC) and combined HCC-CC (CHC) cases than the NSC group, but no significant differences in tumor cell differentiation and history of liver cirrhosis were found between the two groups. The numbers of interventional treatments were similar in both groups (4.57 vs 5.07, P > 0.05). Overall survival was lower in the SC group than the NSC group (P = 0.019), with 1-, 3-, and 5-year survival rates of 82.1% vs 85.1%, 43.2% vs 56.8%, and 27.0% vs 45.2%, respectively. Survival of patients with AJCC stage I disease in the SC group was lower than that of the NSC group (P = 0.029).

CONCLUSION

Seroclearance in patients with hepatitis B-related primary liver cancer has protective effects with respect to tumorigenesis, cirrhosis, and portal hypertension but confers worse prognosis, which may be due to the frequent occurrence of highly malignant ICC and CHC.

Keywords: Primary liver cancer; Hepatitis B surface; Hepatitis B surface seroclearance; Prognosis; Chronic hepatitis B

Core tip: Through strict case-control, we eliminated prognostic confounding factors, such as tumor stage, Child-Pugh score, and therapeutic mode, to determine the impact of hepatitis B surface (HBsAg) seroclearance (SC) on the prognosis of HBV related liver cancer,. Statistical analysis shows that although HBsAg SC is protective in tumorigenesis, liver cirrhosis, and portal hypertension, the prognosis of HBsAg SC patients with primary liver cancer is worse than that of controls.