To investigate the effect of preoperative HBV-DNA quantification levels and antiviral therapy on post-hepatectomy liver failure (PHLF) in patients with HBV-associated hepatocellular carcinoma (HBV-HCC).

A total of 853 patients with HBV-HCC who underwent partial hepatectomy at the First Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2021 were enrolled. The local ethical committee approval was received and the requirement for written informed consent was waived due to the retrospective nature of the study. Among them, 756 patients were male and 97 female, aged from 18 to 84 years, with a median age of 53 years. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of PHLF. A prediction model for PHLF was constructed based on the independent risk factors of PHLF. The area under the ROC curve (AUC), calibration curve and decision curve analysis (DCA) were adopted to analyze the efficiency of the prediction model. Mann-Whitney U test was employed to compare the liver function parameters between two groups. The incidence rates were compared by Chi-square test or Fisher's exact test.

The incidence of PHLF in HBV-HCC patients was 23.9% (204/853). Multivariate Logistic regression analysis identified HBV-DNA≥2 000 IU/ml, age, major hepatectomy, intraoperative blood loss, prealbumin (PA), total bile acid (TBA), Plt and PT as independent risk factors for PHLF (OR=1.489 3, 1.020 2, 3.331 6, 1.000 2, 0.993 7, 1.014 9, 0.995 1, 2.240 3; all P<0.05). Based on the above 8 independent risk factors, a nomogram prediction model for PHLF was constructed. The AUC of this prediction model for PHLF was 0.816. The calibration curve showed high consistency between the risk of PHLF predicted by the model and the actual incidence of PHLF, with a C-index of 0.809 8. DCA also demonstrated that the prediction model yielded more clinical benefits. The incidence of PHLF in patients receiving regular antiviral therapy before surgery was 19.1%(47/246), significantly lower than 25.9%(157/607) in those without regular antiviral therapy (χ²=4.032, P=0.044).

For patients with HBV-HCC undergoing hepatectomy, preoperative HBV-DNA ≥2 000 IU/ml is an independent risk factor for PHLF. Regular antiviral therapy before surgery can effectively reduce the incidence of PHLF.