Hepatitis B Virus Reactivation Potential Risk Factors in Hepatocellular Carcinoma via Transcatheter Arterial Chemoembolization: A Retrospective Research

Abstract

Background. To explore the clinical characteristics of reactivation of hepatitis B virus (HBV) in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). The pathological correlation of prognosis and hepatitis B virus reactivation has been given detailed analyses in our research. Methods. A total of 108 related TACE-treated HCC clinical data from January 2008 to January 2016 was gleaned and involved in this retrospective analysis. To lucubrate the nuance of survival rates between HBV reactivated group and HBV nonreactivated group, clinical data of each patient was analyzed in detail and refined the retrospective studies. Results. HBV reactivation occurred in 42 patients with a proportion of 38.9%. The detected HBV DNA level ≥104 in patients showed a reactivation rate of 65.8% (25/38), which was significantly higher than the HBV DNA < 104 cases (24.3%, 17/70). Research data revealed a conspicuous lower cellular immunity ( P < 0.01 ) and better 2-year survival rate ( P = 0.03 ) in the HBV-reactivated group when compared to the nonreactivated group. Conclusion. Some of the patients with primary hepatocellular carcinoma possibly had HBV reactivation at post-TACE-therapy. And the predominant risk factors of HBV reactivation are positive HBV test and immunosuppression. Our study suggested that HBV reactivation at post-TACE-therapy is an independent predictor of poor prognosis and low survival rate as well as a crucial reason for poor prognosis and lower survival rate, which indirectly proved that it is urgent to necessitate the antiviral therapy and immune enhancer in improving the curative effect and prognosis of HCC patients.

Risk of HBV reactivation during therapies for HCC: A systematic review

“…HBV reactivation was defined as an increase of serum HBV DNA > 1 log or reappearance of HBV DNA in patients with undetectable HBV DNA at baseline in 33 studies, [ 19–21,23–30,32–36,38–43,45–48,50–53,56–58 ] while this definition varied in five studies [ 31,44,49,55,59 ] and was not clearly provided in the remaining three studies. [ 22,37,54 ] A definition of HBV‐related biochemical reactivation was not provided in 18 studies, [ 21–27,30,32–34,37–41,54,59 ] while it varied widely among the remaining 23 studies. [ 19,20,28,29,31,35,36,42–53,55–58 ] Only increases in aminotransferase levels attributed to HBV reactivation by the authors were considered HBV‐related biochemical reactivation.…”

“…Twelve studies including 3474 patients who underwent TACE for HCC provided data for HBV reactivation, which was diagnosed in 517 (14.9%) patients (pooled estimate, 19%, 95% CI, 13%–26%; heterogeneity, p < 0.01) (Table 1 and Figure 4A). [ 19,20,35–43,58 ] The pooled rates of HBV reactivation were higher in 2296 patients who received no prophylactic NA (pooled estimate, 23%; 95% CI, 17%–30%; heterogeneity, p < 0.01) (Figure 4B) [ 19,20,35–43,58 ] than in 1178 patients who did (pooled estimate, 1%; 95% CI, 0%–10%; heterogeneity, p = 0.13) (Figure 4C). [ 35,38–40,43,58 ] The pooled rates of HBV reactivation were 16% (95% CI, 10%–23%; heterogeneity, p < 0.01) in seven studies with mean/median follow‐up ≤6 months [ 20,35,36,39,41,43,58 ] and 23% (95% CI, 11%–42%, heterogeneity, p < 0.01) in three studies with mean/median follow‐up >6 months.…”

“…[ 19,20,35–43,58 ] The pooled rates of HBV reactivation were higher in 2296 patients who received no prophylactic NA (pooled estimate, 23%; 95% CI, 17%–30%; heterogeneity, p < 0.01) (Figure 4B) [ 19,20,35–43,58 ] than in 1178 patients who did (pooled estimate, 1%; 95% CI, 0%–10%; heterogeneity, p = 0.13) (Figure 4C). [ 35,38–40,43,58 ] The pooled rates of HBV reactivation were 16% (95% CI, 10%–23%; heterogeneity, p < 0.01) in seven studies with mean/median follow‐up ≤6 months [ 20,35,36,39,41,43,58 ] and 23% (95% CI, 11%–42%, heterogeneity, p < 0.01) in three studies with mean/median follow‐up >6 months. [ 19,40,42 ] Biochemical reactivation was reported in 144 (10.6%) of 1354 patients from eight studies (pooled estimate, 11%; 95% CI, 6%–20%; heterogeneity, p < 0.01) (Figure 4D).…”

“…Rates of HBV reactivation (A, all patients; B, patients without prophylactic HBV therapy; C, patients with prophylactic HBV therapy) and biochemical exacerbation (D) in studies including HBsAg‐positive patients with HCC who underwent TACE for HCC (Jang et al, [ 19,35,40,42 ] Park et al, [ 20 ] Lao et al, [ 36,58 ] Yu et al, [ 37 ] Shao et al, [ 38 ] Li et al, [ 39 ] X. Wang et al, [ 41 ] Liu et al, [ 43 ] )…”

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

“…Wang et al [ 99 ] reported that HBV DNA-negative patients with HCC still had a risk of HBV reactivation after TACE. Wang et al [ 100 ] reported that HBV reactivation after TACE is an independent prognostic factor and a crucial reason for a poor prognosis and lower survival rate of patients with HCC. However, Xu et al [ 96 ] reported that TACE could decrease the HBV DNA level in patients with HCC.…”