Clinicopathologic characteristics and outcomes of hepatocellular carcinoma associated with chronic hepatitis B versus hepatitis C infection

Abstract

BACKGROUNDHepatocellular carcinoma (HCC) is a primary liver malignancy and one of the most common cancers worldwide. Few studies in Saudi Arabia have compared the clinicopathologic characteristics of HCC caused by hepatitis B virus (HBV) versus hepatitis C virus (HCV) and their effect on patient survival and prognosis.OBJECTIVESIdentify differences in clinicopathological characteristics and outcomes of hepatocellular carcinoma (HCC) caused by HBV versus HCV.DESIGNA retrospective medical records review.SETTINGTertiary medical center in Riyadh.PATIENTS AND METHODSWe included all new cases of HCC with underlying HBV and HCV infection diagnosed between January 2013 and September 2017 that met inclusion criteria.MAIN OUTCOME MEASURESClinical, biochemical, pathological and radiological characteristics, and survival differences were compared between HCC that developed in HBV- and HCV-infected patients.SAMPLE SIZEOf 253 patients evaluated, 172 patients were included in the study.RESULTSOf the 172 patients, 110 (64%) had HCV-associated HCC and 62 (36%) had HBV-associated HCC. More patients with HBV infection were males (P=.003) and were younger (P=.015) than HCV patients. HCV-infected patients who developed HCC had more advanced cirrhosis (P=.048). The prevalence of comorbidities and pre-existing cirrhosis was similar in both groups. Seven patients (6.8%) with underlying HCV developed HCC in the absence of cirrhosis. Patients with HBV-associated HCC were less likely to meet Milan criteria at initial diagnosis than those with HCV-associated HCC (33.9% vs. 52.7%, respectively, P=.017). HBV-associated HCC occurred at a more advanced Barcelona Clinic Liver Cancer stage. The overall median survival and treatment outcome for each modality was comparable.CONCLUSIONSHBV- and HCV-associated HCC have distinct clinical and pathological characteristics, necessitating different screening policies to optimize HCC surveillance and management. However, viral etiology did not affect the treatment outcome and long-term survival.LIMITATIONSConducted in a single-center, retrospective and lacks information about the use of antiviral treatment.

Living-Donor Liver Transplantation for Hepatocellular Carcinoma: Impact of the MELD Score and Predictive Value of NLR on Survival

“…Previous studies have considered viral hepatitis-associated cirrhosis as a survival risk [ 35 , 36 ]. HBV- and HCV-associated HCC have distinct clinical and pathological characteristics; in contrast to chronic HBV infection, patients with HCC and chronic HCV infection tend to be more affected by advanced cirrhosis [ 37 ]. In addition, our patients with high MELD scores received less pre-LT locoregional treatment owing to more severe hepatic dysfunction, including chemo-embolization and ablation.…”

General Oncology Care in the Kingdom of Saudi Arabia

“…Seventy-five percent of Hepatocellular Carcinoma (HCC) cases in Saudi Arabia are attributed to viral hepatitis (hepatitis B and C) with a more recent dominance of HCV over HBV. HCC is rated sixth in Saudi males and ninth in Saudi females among all cancers, with an age-standardized incidence rate of 4.8/100,000 for males and 2.4/100,000 for females [9]. HBV vaccination has become a mandatory requirement for all Saudi children at school entry in addition to a free mass vaccination program among adults in 1989-1990.…”

“…HBV and HPV are recognized infections that lead to cancer development in Saudi Arabia [9,10]. Interventions to limit the risk of contracting these infections were implemented.…”

Exosomal tumor necrosis factor‐α from hepatocellular cancer cells (Huh‐7) promote osteoclast differentiation

“…2 Etiological factors of HCC include chronic hepatitis B, hepatitis C viral infections, alcoholic liver disease, and nonalcoholic steatohepatitis. 3 In HCC, the intra-hepatic stage III and IV tumor is associated with extra-hepatic metastasis. The most preferred site of HCC metastasis includes lung (6.2%-7.2%), bone (3.4%-4.5%), and brain (0.3%-0.4%).…”

“…HCC‐related mortality is one of the leading causes of cancer‐related death in Taiwan 2 . Etiological factors of HCC include chronic hepatitis B, hepatitis C viral infections, alcoholic liver disease, and nonalcoholic steatohepatitis 3 . In HCC, the intra‐hepatic stage III and IV tumor is associated with extra‐hepatic metastasis.…”