Pre‐ and post‐operative HBsAg levels may predict recurrence and survival after curative resection in patients with HBV‐associated hepatocellular carcinoma

Purpose To investigate pre‐ and post‐operative levels of HBsAg influence prognosis of patients with hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) after curative resection. Methods Medical records were retrospectively analyzed for 881 patients with HBV‐related HCC treated by curative resection. Patients were classified as having high or low serum HBsAg levels (≥200 or <200 ng/mL) pre‐ or post‐operatively. Results OS and RFS were better for patients with low pre‐operative serum levels of HBsAg than for those with high levels. Similarly, OS was better among patients with low post‐operative serum levels of HBsAg than among those with high levels. RFS, in contrast, was similar between these two groups. After generating propensity score‐matched pairs of patients, OS was higher in patients with falling post‐operative HBsAg levels than in those with rising levels. In contrast, RFS was similar between these two groups. Antiviral nucleoside analog therapy prolonged OS in patients with high pre‐operative HBsAg levels. Conclusions Low pre‐ and post‐operative levels of HBsAg may be associated with better long‐term survival in patients with HBV‐related HCC. Pre‐operative serum levels of HBsAg ≥200 ng/mL may identify patients more likely to benefit from antiviral treatment.