Liver cancer patients with high serum levels of hepatitis B virus face poorer outcomes

In the June issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD), researchers report their findings from the first-ever study examining the prognostic value of serum HBV DNA levels for patients with liver cancer undergoing chemotherapy.

They found that patients with high pre-chemotherapy levels of HBV DNA had a significantly increased incidence of severe hepatitis which was associated with the worst survival. The article is also available online at Wiley Interscience (http://www.interscience.wiley.com/journal/hepatology).

HBV is associated with a more than 200-fold increase in risk of liver cancer. In areas where HBV is endemic, like China and the Far East, the great majority of cases of hepatocellular carcinoma (HCC) occur in individuals with the virus. For most patients whose cancer is inoperable, chemotherapy is one of the main treatment options, and still the prognosis is dismal. Survival is often measured in months.

Researchers, led by Winnie Yeo of the Chinese University of Hong Kong, examined the significance of pre-chemotherapy HBV DNA levels in the blood on the survival of HCC patients. They studied 188 patients participating in a phase III randomized controlled trial comparing two different chemotherapy regimens. One hundred and seventy patients (92 percent) had evidence of HBV infection. Of these, 125 had sera available to determine HBV DNA levels and were included in the study.

For each patient, the researchers measured the level of HBV DNA in the blood before the start of chemotherapy. They also gathered other potentially important prognostic information, like age, sex, total bilirubin and presence of cirrhosis. Over the course of each patient's treatment, the researchers monitored blood counts, renal and liver function and clinical signs and symptoms. They then performed statistical analysis to assess which factors might have influenced patient outcomes.

The median survival of all patients was 6.83 months. Patients with high pre-treatment HBV DNA had a significantly higher incidence of developing severe hepatitis during chemotherapy and had poorer survival. Other factors significantly affecting survival were high total bilirubin and HCV infection.

"The present study has shown that a pre-chemotherapy viral load higher than 10(5.65) copies per milliliter is associated with poorer survival in HCC patients with chronic HBV infection, and this association is independent of an individual's hepatic reserve, tumor and clinical factors," the authors report.

Though the study was limited by a small patient cohort, and the fact that all had advanced disease, the authors concluded, "Based on the present findings, the incorporation of anti-viral therapies to reduce HBV viral load should be considered as part of management for HCC patients undergoing chemotherapy."