Differences in surgical outcomes between hepatitis b and hepatitis C-related hepatocellular carcinoma a retrospective analysis of a single North American center

Objective: Compare surgical outcomes for hepatitis B virus (HBV) hepatocellular carcinoma (HCC) versus hepatitis C virus (HCV) hepatocellular carcinoma (HCC).

Background: HCC is the second leading cause of death from cancer worldwide and is associated with hepatitis virus infection in 80% of cases.

Methods: Between 1997 and 2011, 1008 patients with hepatitis B (HBV, n = 431) or hepatitis C (HCV, n = 577) underwent resection (n = 567) or transplantation (n = 441). Resection was indicated for Child's A patients with single HCC; transplantation was indicated for patients within Milan criteria. Univariate and multivariate analyses were performed as well as survival and recurrence analysis using logrank test.

Results: Based on uniform application of these criteria, resection: transplantation ratio was 3.6 for patients with HBV and 0.67 for patients with HCV. Resection: Patients with HBV had larger tumors and higher αfetoprotein but less satellites and macrovascular invasion; 68% of HBV versus 89% of HCV were cirrhotic. Survival was better (P 0.001) and recurrence was lower (P = 0.009) for HBV. Independent predictors of death included HCV (P = 0.024), transfusion (P = 0.013), and HCC of greater than 5 cm (P = 0.013). Limiting analysis to patients with cirrhosis, survival with HBV remained superior (P = 0.020) but recurrence did not. Transplantation: Tumors were similar in HBV and HCV. Survival was better (P = 0.002) for HBV; recurrence was similar. Independent predictors of death were HCV (P 0.001), poor differentiation (P = 0.049), vascular invasion (P = 0.002), and outside Milan (P = 0.032). Limiting analysis to patients within Milan, HBV survival remained better for both resection (P = 0.030) and transplantation (P = 0.002).

Conclusions: Survival after both resection and transplantation for HCC was better in HBV than in HCVrelated HCC whereas recurrence was also lower for HBVHCC in the resection group, these differences are influenced by both liver and tumor factors.