Serum Bile Acids Are Useful Indicators of Intrahepatic Recurrence After Initial Curative Hepatectomy for Hepatocellular Carcinoma

ABSTRACT Aim Bile acids accumulation in hepatocytes causes liver damage and contributes to the development of hepatocellular carcinoma. However, the association between serum bile acid levels and postoperative intrahepatic recurrence in hepatocellular carcinoma remains unclear. We investigated the effect of preoperative serum bile acid levels on intrahepatic recurrence in patients with hepatocellular carcinoma following initial curative hepatectomy. Methods This retrospective study included 249 patients with hepatocellular carcinoma who had preoperative serum bile acid levels measured and underwent initial curative hepatectomy between April 2010 and December 2018. We investigated the associations among serum bile acid levels, liver fibrosis, and postoperative outcomes in these patients. Results Patients with high serum bile acid levels had a high prevalence of hepatitis C virus‐positive, a high proportion of preoperative ursodeoxycholic acid use, and poor liver reserve function. These patients had more severe pathological liver fibrosis and necro‐inflammatory reaction and blood‐based markers for liver fibrosis were higher than those in patients with low serum bile acid levels. Compared with blood‐based markers for liver fibrosis, serum bile acids were more accurate prognostic indicators of intrahepatic recurrence. High serum bile acid levels were associated with poor overall survival and high intrahepatic recurrence rates in patients with hepatocellular carcinoma following initial curative hepatectomy. High serum bile acid levels represented an independent risk factor for postoperative intrahepatic recurrence. Conclusions Serum bile acid levels reflect both the degree of liver fibrosis and necro‐inflammatory reaction and are associated with postoperative intrahepatic recurrence in patients with hepatocellular carcinoma following initial curative hepatectomy.