Quantitative analysis of plasma HBV DNA for early evaluation of the response to transcatheter arterial embolization for HBV-related hepatocellular carcinoma

Abstract

Transcatheter arterial embolization (TAE) is an important palliative treatment for patients with hepatocellular carcinoma (HCC) who are poor candidates for surgery or percutaneous ablative therapy. It generally takes 4 wk after lipiodol-TAE to properly assess lipiodol retention on computed tomography (CT). HBV DNA is integrated into the genome of HCC cells, and circulating plasma DNA may serve as a marker for cell damage. We assessed changes in plasma HBV DNA after TAE in HBV-related HCC and correlated the levels with the pattern of lipiodol accumulation on CT. Between April and June 2001, 14 patients with HBV-associated HCC who underwent TAE for inoperable or recurrent tumor were studied. Levels of plasma HBV DNA were measured by real-time quantitative PCR daily for five consecutive days after TAE. More than twofold elevation of circulating HBV DNA was considered as a definite elevation. Abdominal CT was performed 1-2 mo after TAE for the measurement of lipiodol retention. Circulating HBV DNA in 10 out of 13 patients was elevated after TAE, except for one patient whose plasma HBV DNA was undetectable before and after TAE. In group I patients (n = 6), the HBV DNA elevation persisted for more than 2 d, while in group II (n = 7), the HBV DNA elevation only appeared for 1 d or did not reach a definite elevation. There were no significant differences in age or tumor size between the two groups. Patients in group I had significantly better lipiodol retention (79.31+/-28.79%) on subsequent abdominal CT than group II (18.43+/-10.61%) (P = 0.02). Patients with durable HBV DNA elevation for more than 2 d correlated with good lipiodol retention measured 1 mo later, while others associated with poor lipiodol retention. Thus, circulating HBV DNA may be an early indicator of the success or failure of TAE.