Kazunari Sasaki1, Junichi Shindoh2, Yujiro Nishioka3, Georgios A Margonis1, Toshitaka Sugawara3, Nikolaos Andreatos1, Masaji Hashimoto3, Timothy M Pawlik4. 1. Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA. 2. Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. shindou-tky@umin.ac.jp. 3. Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. 4. Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Abstract
BACKGROUND AND AIM: Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear. METHODS: Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed. RESULTS: Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2-5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13-2.13). CONCLUSION: HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.
BACKGROUND AND AIM: Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear. METHODS: Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed. RESULTS: Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2-5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13-2.13). CONCLUSION:HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.
Entities:
Keywords:
Hepatectomy; Hepatitis B virus; Hepatitis C virus; Hepatocellular carcinoma; Liver cirrhosis
Authors: L Tornillo; V Carafa; J Richter; G Sauter; H Moch; E Minola; M Gambacorta; L Bianchi; R Vecchione; L M Terracciano Journal: J Pathol Date: 2000-11 Impact factor: 7.996
Authors: A J Freeman; G J Dore; M G Law; M Thorpe; J Von Overbeck; A R Lloyd; G Marinos; J M Kaldor Journal: Hepatology Date: 2001-10 Impact factor: 17.425
Authors: Jonghun J Lee; Peter T W Kim; Sandra Fischer; Scott Fung; Steven Gallinger; Ian McGilvray; Carol-Anne Moulton; Alice C Wei; Paul D Greig; Sean P Cleary Journal: Ann Surg Oncol Date: 2014-05-08 Impact factor: 5.344