Differences in Surgical Outcomes Between Hepatitis B- and Hepatitis C-Related Hepatocellular Carcinoma A Retrospective Analysis of a Single North American Center

作者：Franssen Bernardo; Alshebeeb Kutaiba; Tabrizian Parissa; Marti Josep; Pierobon Elisa S; Lubezky Nir; Roayaie Sasan; Florman Sander; Schwartz Myron E^*

来源：Annals of Surgery, 2014, 260(4): 650-658.

DOI：10.1097/SLA.0000000000000917

• HCC
• hepatitis B
• hepatitis C
• hepatocellular carcinoma
• liver cancer

Objective: Compare surgical outcomes for hepatitis B virus (HBV)-hepatocellular carcinoma (HCC) versus hepatitis C virus (HCV)-hepatocellular carcinoma (HCC). %26lt;br%26gt;Background: HCC is the second leading cause of death from cancer worldwide and is associated with hepatitis virus infection in 80% of cases. %26lt;br%26gt;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%26apos;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 log-rank test. %26lt;br%26gt;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 alpha-fetoprotein but less satellites and macrovascular invasion; 68% of HBV versus 89% of HCV were cirrhotic. Survival was better (P %26lt; 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 %26lt; 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). %26lt;br%26gt;Conclusions: Survival after both resection and transplantation for HCC was better in HBV- than in HCV-related HCC whereas recurrence was also lower for HBV-HCC in the resection group, these differences are influenced by both liver and tumor factors.

• 出版日期2014-10