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10.1245/s10434-007-9570-x
Annals of Surgical Oncology 14:3181-3187 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Hepatitis B Virus Infection Predicts Extrahepatic Metastasis After Hepatic Resection in Patients With Large Hepatocellular Carcinoma

Atsushi Sasaki, MD1,2, Seiichiro Kai, MD2, Yuichi Endo, MD2, Kentaro Iwaki, MD2, Hiroki Uchida, MD2, Kohei Shibata, MD2, Masayuki Ohta, MD2 and Seigo Kitano, MD2

1 Department of Surgery, National Hospital Organization Miyazaki Hospital, Miyazaki, 889-1301, Japan
2 Department of Surgery I, Oita University Faculty of Medicine, Oita, 879-5593, Japan

Correspondence: Address correspondence and reprint requests to: Atsushi Sasaki, MD; E-mail: sasakia{at}med.oita-u.ac.jp

Background: Although extrahepatic metastasis occurs rarely after hepatic resection for hepatocellular carcinoma (HCC), the prognosis of these patients is extremely poor. Predictors of extrahepatic metastasis have not been fully investigated.

Methods: To identify predictors of extrahepatic metastasis after resection, we retrospectively investigated 77 patients with HCC tumors >50 mm in diameter who underwent hepatic resection. We investigated correlations between postoperative extrahepatic metastasis and clinicopathologic factors as well as extrahepatic metastasis-free survival rate by log rank test and predictors of extrahepatic metastasis by univariate and multivariate logistic regression models.

Results: Hepatitis B surface antigen (HBs-Ag) was found in 25 (32.5%) of 77 patients, and extrahepatic metastasis occurred in 26 (33.8%). Patients with extrahepatic metastasis showed better liver function and a high occurrence of HBs-Ag positivity than those without. The 5-year extrahepatic metastasis-free survival rate was worse in patients with HBs-Ag positivity, larger tumors (≥70 mm), higher alfa-fetoprotein level (≥300 ng/mL), and lower indocyanine green retention rate at 15 minutes (ICGR15) (<15%) than in those without. By univariate logistic regression analysis, HBs-Ag positivity, larger HCC tumor (≥70 mm), lower ICGR15 (<15%), and lower preoperative lymphocyte count (<1000/mm3) were predictors of extra-hepatic metastasis (P < .1). By multivariate analysis, HBs-Ag positivity was an independent predictor of postoperative extrahepatic metastasis (P = .04).

Conclusions: In patients positive for HBs-Ag, radiologic examination of extrahepatic organs should be performed as a part of the postoperative surveillance. Hepatitis B virus infection may promote establishment of extrahepatic metastasis.

Key Words: Hepatocellular carcinoma • Extrahepatic metastasis • Hepatic resection • Recurrence • Prognosis • Hepatitis B virus






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