Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels

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Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death in the world.1 Hepatic resection is a well-accepted therapy for HCC, but high postoperative tumor recurrence remains a major obstacle for long-term survival.2 A 2008 study3 found a high serum level of hepatitis B virus (HBV) DNA to be an important predictor of recurrence. Although patients with HBV DNA levels of less than 2000 IU/mL are usually designated as inactive or low-risk HBV carriers,4,5 the postoperative tumor recurrence rate among these patients is still high.6 Since 2010, hepatitis B surface antigen (HBsAg) quantification has become recognized increasingly as a marker for evaluating viral replication and possible host immune control over HBV infection.7-9 However, few studies have evaluated HBsAg level as a predictor of postoperative recurrence of HCC, especially in patients with low HBV DNA levels. The primary aim of this study was to assess the significance of HBsAg level in predicting postoperative HCC recurrence in patients with low HBV load.