Baseline HBV‐DNA load plus AST/ALT ratio predicts prognosis of HBV‐related hepatocellular carcinoma after hepatectomy: A multicentre study

Abstract

Hepatitis B viral (HBV) load and hepatic enzymes play a critical role in hepatocellular carcinoma (HCC) development. However, the clinical significance of these in HBV‐related HCC patients after hepatectomy remains unclear. In this study, we analysed 1,940 HBV‐related HCC patients who underwent hepatectomy from four hospitals in west China. Risk classification was constructed based on baseline HBV‐DNA load and AST/ALT ratio. Based on the HBV‐DNA load and AST/ALT ratio classification, four types with distinguishable prognoses were established. Type 1 patients had the best prognosis with 5‐year overall survival (OS) of 69.8%, followed by type 2 and type 3 patients, whereas type 4 patients had the worst prognosis with 5‐year OS of 42.7%. Similarly, the four types had statistically different recurrence‐free survival. This classification was significantly associated with HCC recurrence (hazard ratio [HR]:1.492, p < .001) and long‐term survival (HR: 1.574, p = .001). Pathologically, type 4 correlated with more advanced tumours considering tumour size and microvascular invasion than those in type 1, 2, or 3. Moreover, type 4 patients had more severe hepatic inflammation in underlying liver. Conversely, type 1 patients had an active tumour immune microenvironment as indicated by more CD8+ T cell infiltration and less PD‐L1 expression. In conclusion, the classfication based on baseline HBV‐DNA load and AST/ALT ratio could effectively stratify HBV‐related HCC patients with distinguishable prognoses after hepatectomy.

The prognostic role of the AST/ALT ratio in hepatocellular carcinoma patients receiving thermal ablation combined with simultaneous TACE

“…Since Fernando De Ritis first described AST/ALT ratio as an enzymatic test for viral hepatitis in 1957 [ 14 ], researchers have taken it as a potential prognostic biomarker in various diseases [ 8 – 13 , 15 , 16 ]. Also, Granito et al [ 17 ] evaluated the prognostic significance of changes in liver parameters as predictors of treatment response to cTACE.…”

Development and Validation of a Prognostic Score for Hepatocellular Carcinoma Patients in Immune Checkpoint Inhibitors Therapies: The Hepatocellular Carcinoma Modified Gustave Roussy Immune Score

“…According to previous experience, the decreased ALB, increased LDH or increased NLR has been proved to be independent negative prognostic factors for OS ( Arkenau et al, 2008 ; Bigot et al, 2017 ). The AST-to-ALT ratio was reported to stratify HBV-related HCC patients with distinguishable prognosis effectively after hepatectomy ( Shen et al, 2021 ). And the TBIL was also found as a prognostic factor for OS in terms of HCC patients previously ( Yang et al, 2020 ).…”

Preoperative serum hepatitis B virus DNA was a risk factor for hepatocellular carcinoma recurrence after liver transplantation

“…The reason might be detectable HBV DNA per se promote tumour cell growth. Studies reported that preoperative serum HBV DNA and Ishak hepatic inflammation score are risk factors for HCC recurrence after hepatectomy [ 4 , 6 , 7 ]. We found that hepatic inflammation was not a risk factor for HCC recurrence because patients had a normal liver function after OLT.…”

“…In Asia, the most common aetiology of HCC is CHB infection. A serum hepatitis B virus DNA (HBV DNA) level is correlated with the risk of HCC [ 2 , 4 , 5 ], and serum HBV DNA detectable and HBV DNA >2000 IU/mL are risk factors for HCC recurrence after hepatectomy [ 4 , 6 , 7 ]. Whether preoperative HBV DNA status is a risk for HCC recurrence after OLT is unclear, therefore, we recruited patients with HCC who had OLT from a referral medical centre and explored risk factors for HCC recurrence and characteristics of patients with HCC and detectable HBV DNA.…”