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
ARTICLE HIGHLIGHTS
Research background

Hepatitis B surface antigen (HBsAg) seroclearance is considered the gold standard for hepatitis B virus (HBV) clearance and chronic hepatitis B cure. Existing studies have confirmed that HBsAg seroclerance could result in significantly improved liver histology and biochemistry in patients with chronic HBV, but a certain incidence of liver cancer still exists. The current question is whether HBsAg seroclerance plays a role in the prognosis of liver cancer patients. Due to the small number of such patients, there is currently no reliable research and conclusion.

Research motivation

The effect of HBsAg seroclearance on prognosis in hepatitis B-related primary liver cancer remains unclear. The solution to this problem would improve the understanding of the etiology and pathogenesis of HBV-related liver cancer and to guide clinical treatment.

Research objectives

Our objective was to assess the impact of HBsAg seroclearance on survival outcomes in hepatitis B-related primary liver cancer.

Research methods

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

Research 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. Overall survival was lower in the SC group than the NSC group (P = 0.019). Survival of patients with AJCC stage I disease in the SC group was lower than that of the NSC group (P = 0.029).

Research conclusions

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, likely due to the frequent occurrence of highly malignant ICC and CHC.

Research perspectives

This is the first reliable study about the effect of HBsAg seroclearance on the prognosis of hepatitis B-related liver cancer. In the future, more SC patients should be accumulated, and it is necessary to further verify this result by propensity score matching.