Potential risk factors for the reactivation of the replication of hepatitis B and C viruses after transcatheter arterial chemoembolization of hepatocellular carcinoma

Abstract

The purpose of this study was to investigate the potential risk factors for the reactivation of the replication of hepatitis B virus (HBV) and hepatitis C virus (HCV) after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma. Forty-four hepatocellular carcinoma patients treated by TACE using epirubicin plus mitomycin C were studied. Serum HBV DNA (n=17) and HCV RNA (n=27) levels were measured 1 day before and 3 months after TACE. Plasma concentrations of chemotherapeutic agents were determined at 1 hour and 72 hours after TACE. A total of 29 patients (n=13 for chronic hepatitis Band n=16 for chronic hepatitis C) showed significant changes of the viral loads after TACE. Patients with increased viral loads after TACE were older (p=0.041), had higher incidence of pre-TACE white blood cell counts being less than normal limit (p=0.023), and had higher plasma mitomycin C concentrations (p=0.039) than those in patients with decreased viral loads. Analysis by multiple logistic regressions using age, decreased or normal pre-TACE white blood cell counts, mitomycin C concentrations >3.95 ng/mL adopted by receiver operating characteristic curve (p=0.037), and epirubicin concentrations have shown that decreased pre-TACE white blood cell counts was the only significant factor associated with increased viral loads after TACE (p=0.048). In conclusion, patients with decreased pre-TACE white blood cell counts have a potential risk for the reactivation of the replication of HBV or HCV after TACE.

Figure 1

Plasma mitomycin C concentrations after transcatheter arterial chemoembolization. The higher plasma concentration of mitomycin C in two measurements was applied for analysis. •, increased viral loads after chemoembolization; ▲, decreased viral loads after chemoembolization. p  =  0.039 for total and p  >  0.05 for HBV and HCV (Mann‐Whitney test). HBV  =  hepatitis B virus; HCV  =  hepatitis C virus.

Figure 2

Plasma epirubicin concentrations after transcatheter arterial chemoembolization. The higher plasma concentration of epirubicin in two measurements was applied for analysis. •, Increased viral loads after chemoembolization; ▲, decreased viral loads after chemoembolization. p  >  0.05 for total, HBV, and HCV (Mann‐Whitney test). HBV  =  hepatitis B virus; HCV  =  hepatitis C virus.