Preoperative HBsAg seroclearance affects long-term outcomes for hepatitis B virus-related hepatocellular carcinoma after liver resection: a multicenter analysis.

[BACKGROUND & AIMS] We aimed to investigate the impact of HBsAg seroclearance on the long-term prognosis of HBV-related HCC following curative liver resection.

[METHODS] Patients treated with curative-intent hepatectomy for HBV-related HCC in 4 Chinese hospitals were enrolled. Patients were stratified into HBsAg-positive and HBsAg-seroclearance groups. Overall survival (OS) and time-to-recurrence (TTR) were compared between HBsAg-positive and HBsAg-seroclearance patients using propensity score matching (PSM). Independent risk factors of OS, cancer-specific survival (CCS) and TTR were identified by univariable and multivariable Cox regression and competing risk regression analyses.

[RESULTS] Among 1008 HBV-related HCC patients, 81 (8.0%) patients achieved HBsAg seroclearance before surgery. Patients in HBsAg-seroclearance groups had better liver function reserve. Postoperative morbidity was comparable between the two groups before and after PSM. In the entire cohort, the Kaplan-Meier curves showed that HBsAg-seroclearance patients had better OS (p = 0.022) and TTR (p < 0.001). However, there was no significant difference between the two groups of patients regarding OS (p = 0.134) in the PSM cohort. Multivariable Cox regression and competing risk regression analyses demonstrated that HBsAg seroclearance was independently associated with lower TTR (p < 0.05), but not with better OS and CSS (p > 0.05).

[CONCLUSIONS] Preoperative HBsAg seroclearance is associated with a lower risk of TTR for HBV-related HCC among patients undergoing curative hepatectomy.