Differences in Long-term Outcome and Prognostic Factors According to Viral Status in Patients with Hepatocellular Carcinoma Treated by Surgery

Abstract

Long-term postoperative survival and prognostic factors were examined retrospectively in patients with hepatocellular carcinoma (HCC) with serum hepatitis B surface antigen (HBsAg) or hepatitis C antibody (HCVAb) and in those without virus infection. Subjects were 265 consecutive HCC patients treated surgically at one institution during the period 1990 to 2006. Postoperative survival was analyzed and compared between HBsAg-positive (B-HCC), HCVAb-positive (C-HCC), and hepatitis B- and C-negative (NBNC-HCC) patients. Prognostic factors for overall and recurrence-free survival were also analyzed. Overall and recurrence-free survival rates were significantly higher in the NBNC-HCC group than in the C-HCC group. Significant prognostic factors for overall survival identified by univariate and multivariate analyses were age, serum alkaline phosphatase (ALP) level, tumor multiplicity, portal vein invasion (Vp), hepatic vein invasion (Vv), and operative blood loss in the B-HCC group; serum albumin level, ALP level, tumor size, and Vv in the C-HCC group; and tumor multiplicity in the NBNC-HCC group. Significant factors for recurrence-free survival were age, ALP level, tumor multiplicity, Vp, and operation time in the B-HCC group; ALP level, prothrombin time, tumor size, Vv, and width of the surgical margin in the C-HCC group; and age, tumor size, tumor multiplicity, and Vp in the NBNC-HCC group. Thus, postoperative survival and prognostic factors in cases of HCC differ according to the presence of serologic viral markers.

Predictors of Recurrence in Hepatitis C Virus Related Hepatocellular Carcinoma after Hepatic Resection: A Retrospective Cohort Study

“…HCCs associated with high AFP level had a higher cell proliferative activity and more aggressive behaviour [20]. In our study, AFP was a significant predictor of HCC recurrence; similar to other studies evaluating HCV related HCCs [3,21] and hepatitis B virus (HBV) related HCCs [13,22]. Hepatocellular carcinoma (HCC) is characterized by its high affinity for vascular invasion (microvascular or microvascular invasion), which indicates aggressive biological manner of the tumour and is currently one of the most grave predictors of HCC recurrence [23].…”

Delayed Diagnosis of HCC with Chronic Alcoholic Liver Disease

“…These data partly contradict a Japanese retrospective analysis revealing higher overall and progression-free survival for patients with HCC not attributable to HBV or HCV infection [34]. For patients with chronic HBV infection it has been shown that successful treatment of the infection prolongs survival of patients with nonresectable HCC treated by chemoembolization [35], and after curative treatment [36].…”

Surgical Outcomes for Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

“…14 Previous studies 14,15,[30][31][32][33][34][35][36][37][38][39][40][41][42][43] indicate that early recurrence (i.e., within approximately 2 years of resection) includes both intrahepatic metastases from primary and multicentric lesions, whereas late recurrence (i.e., >2 years after resection) is predominantly of multicentric origin. In the present study, cumulative disease-free survival plateaued 2 years after resection in the NAFLD group (Fig.…”

“…In contrast, others reported higher frequencies of intrahepatic recurrences and lower survival rates for patients with HCV-related HCC compared to patients infected with hepatitis B virus or with non-B non-C hepatitis. [11][12][13][14][15] There is little information in the literature regarding comparative analyses of surgical outcomes between patients with NAFLD-related HCC and patients with hepatitis virus-related HCC. Thus, there is no consensus concerning differences in surgical outcomes in patients with HCC depending on the underlying liver disease.…”