Abstract: Objective The aim of this study was to investigate the impact of low-level viremia (LLV) on prognosis in patients with hepatitis B virus-related hepatocellular carcinoma (HCC)after transarterial chemoembolization (TACE) therapy. Methods 119 patients with HBV-related HCC were admitted to our hospital between January 2016 and December 2020, and all patients received comprehensive anti-tumor therapy based on TACE and nucleoside (acid) analogs(NAs) for antiviral therapy. All patients were followed-up to December 31,2021. Results Among the 119 patients,42(35.3%) had LLV after antiviral therapy; serum HBeAg positive rate in patients with LLV was 64.3%, significantly higher than that in the non-LLV group (27.3%, P＜0.05); at the end of 3 months after TACE treatment, the ORR in patients with LLV was significantly lower than that in the non-LLV group(33.3% vs. 58.4%, P＜0.05); 6 months after treatment, serum ALT, AST, Child-Pugh score and AFP levels in patients with LLV were 35.0(28.6,56.0)U/L, 56.0(43.6, 78.5)U/L, 7.0(6.0, 8.0) and 2732.0(85.7, 17595.0) ng/ml, significantly higher than [29.0(21.0, 43.0)U/L, 40.0(27.0,61.0)U/L, 6.0(5.0,7.0) and 22.5(5.2, 780.6)ng/ml, respectively, P＜0.05] in the non-LLV group; the 2-year survival in patients with LLV was 2.4%, significantly lower than 41.6% (P＜0. 05) in the non-LLV group; the multivariate Logistic analysis showed that with or without LLV [HR (95%CI): 2.1(1.3-3.3)], Barcelona Clinic Liver Cancer(BCLC) stage [HR(95%CI): 1.7(1.2-1.9)] and radiofrequency ablation [HR(95%CI):0.4 (0.2-0.7)] were the independent prognostic factors for patients with HBV-related HCC (P＜0.05). Conclusion Serum HBeAg positive might influence antiviral response to NAs therapy, and the LLV might impact the prognosis of patients with HBV-related HCC after TACE treatment, which warrants concerns clinically.

Key words: Hepatoma, Hepatitis B, Nucleos(T)ide analogs, Low-level viremia, Transarterial chemoembolization, Prognosis