Hepatitis B viral load as a prognostic factor for patients with unresectable hepatocellular carcinoma

HBV infection is a global health problem that causes a wide spectrum of clinical manifestations, including inactive carrier status, chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Several host and viral factors have been identified that affect the long-term outcomes of HBV carriers. Recently, data from prospective cohort or case-control studies indicated that high baseline HBV viral loads in the immune clearance phase are associated with an increased risk of cirrhosis and HCC development, In addition, hepatitis flare due to HBV reactivation is a serious cause of liver-related morbidity and mortality in HBV carriers undergoing cytotoxic or immunosuppressive therapy. The results presented by Yeo et al. demonstrated that, for HBV-related unresectable HCC patients, a high HBV viral load prior to systemic chemotherapy served as an adverse factor for patient survival. These lines of evidence suggest that in addition to conventional clinical factors (such as the extent of tumor, hepatic reserve, the performance status of patients and efficacy of treatment), baseline HBV viral load may play a prognostic role in HBV-related HCC. Prophylactic antiviral therapy might be effective in reducing hepatitis flare due to HBV reactivation and may improve survival for HBV-related unresectable HCC patients undergoing systemic chemotherapy.