Viral load is a significant prognostic factor for hepatitis B virus-associated hepatocellular carcinoma

Cancer. 2002 May 15;94(10):2663-8. doi: 10.1002/cncr.10557.


Background: Hepatitis B virus (HBV) is closely linked to hepatocellular carcinoma (HCC). The objective of the current study was to identify the factors involved in the prognosis of patients with HBV-associated HCC using multivariate analysis.

Methods: The current study included 74 patients with HBV-associated HCC who were admitted to Nagasaki University Hospital, Nagasaki, Japan, between 1983-1998. Of these, 13 patients underwent surgical tumor resection; 43 patients received nonsurgical treatment with transcatheter arterial embolization, percutaneous ethanol injection, or both; and 18 patients were followed without any active treatment. The significance of the patient's age; gender; history of blood transfusion; alcohol use; serum levels of alanine aminotransferase, alpha-fetoprotein, and HBV-DNA; number and size of liver tumors; clinical stage; and histologic diagnosis of HCC as prognostic factors was evaluated using univariate and multivariate analyses.

Results: The 3-year, 5-year, and 10-year postdiagnosis cumulative survival rates were 36%, 21%, and 17%, respectively. Multivariate analysis identified the level of serum HBV-DNA and tumor size at diagnosis as independent and significant prognostic factors (P = 0.0022 and P = 0.0106, respectively). In addition, a low level of viremia was found to be associated with longer survival (P = 0.0057) even in patients who were negative for the hepatitis B e antigen.

Conclusions: The results of the current study suggest that viral load is a useful prognostic marker for HBV-related HCC and that HCC patients with a less favorable course appear either to clear the virus poorly or to have a greater level of virus production.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / virology*
  • DNA, Viral / blood
  • Female
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B e Antigens
  • Hepatitis B virus / isolation & purification*
  • Hepatitis B, Chronic / complications
  • Hepatitis C Antibodies / blood
  • Humans
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / virology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Survival Rate
  • Viral Load


  • DNA, Viral
  • Hepatitis B Surface Antigens
  • Hepatitis B e Antigens
  • Hepatitis C Antibodies