Erschienen in:
01.06.2007
Chronic Viral Hepatitis and Hepatocellular Carcinoma
verfasst von:
Yagil Barazani, Jonathan R. Hiatt, Myron J. Tong, Ronald W. Busuttil
Erschienen in:
World Journal of Surgery
|
Ausgabe 6/2007
Einloggen, um Zugang zu erhalten
Abstract
Background
Hepatocellular carcinoma (HCC) is the third leading cause of death from malignancy worldwide, and its increasing incidence parallels rising global rates of hepatitis B (HBV) and hepatitis C (HCV).
Methods
This retrospective review was undertaken to identify differences in the epidemiology and tumor characteristics of 255 patients with HCC due to chronic HBV (n = 105) or HCV (n = 150).
Results
Hepatitis B patients were predominantly Asian (84%), whereas HCV patients were predominantly Caucasian (72%; p < 0.0001). Hepatitis B patients exhibited stronger family histories of liver disease (54%) and HCC (33%), whereas HCV risk factors included blood transfusion (56%), intravenous drug abuse (31%), and alcohol consumption (44%; p < 0.0001 for all comparisons). Pretreatment laboratory values showed lower albumin and platelet levels but higher bilirubin and AST levels in HCV versus HBV patients (p < 0.0001 to 0.01). As cirrhosis was present in nearly all HCV patients, but only in 79% of HBV patients, HCV patients had more stigmata of portal hypertension, including ascites (65%), varices (86%), splenomegaly (77%), and encephalopathy (41%; p < 0.0002 for all comparisons). Although tumors in HBV patients were larger (7.3 cm versus 5.1 cm; p = 0.0001) and more frequently bilobar, the tumor grade, number of tumors, and metastases were similar for both groups. Hepatitis C patients received less treatment, including chemoembolization and surgical resection. The 5-year survival was higher in HBV patients compared to HCV patients (56% versus 36%, p = 0.046).
Conclusions
Patients with HBV- and HCV-related HCC have different epidemiologic, clinical, and survival characteristics. More HCV patients presented with advanced cirrhosis, received less aggressive treatment, and experienced lower 5-year survival.