Comparison of clinico-pathological features in hepatitis B virus-associated hepatocellular carcinoma with or without hepatitis D virus superinfection.
OBJECTIVE
Hepatitis D virus superinfection in hepatitis B virus carriers produces additional damage in an already injured liver. Earlier reports noted that the development of hepatocellular carcinoma may be accelerated in hepatitis D virus-superinfected patients. This study aimed to investigate the impact of hepatitis D virus on the clinical course of hepatitis B virus-associated hepatocellular carcinoma.


METHODS
A total of 42 consecutive hepatocellular carcinoma cases seropositive for antibody against hepatitis D virus antigen (anti-HDV) were found from 1986 to 1994; the clinical manifestations, treatment and outcomes were compared with 255 consecutive hepatocellular carcinoma cases seropositive for hepatitis B virus surface antigen but seronegative for anti-HDV.


RESULTS
The mean age was 60 years in both groups of patients. Other features, including sex, duration of follow-up, presence of cirrhosis or ascites, serum biochemistry, status of HBV-e antigen, and gross and microscopic tumor appearance, were not significantly different between the two groups. Though more patients in the anti-HDV-positive group underwent active treatment (operation or transcatheter arterial chemoembolization) than those in the anti-HDV-negative group (54.8% in 42 versus 34.9% in 255 cases, p = 0.02), the cumulative 4-year survival rates (9.5% versus 9.8%) were similar. For the anti-HDV-positive hepatocellular carcinoma patients, tumor size < 5 cm and active treatment were favorable prognostic predictors associated with survival > 18 months.


CONCLUSIONS
Hepatitis D virus superinfection does not accelerate the development of hepatocellular carcinoma. The clinical manifestations were similar, and the outcome in anti-HDV-positive patients was not worse than in the general HBV-associated hepatocellular carcinoma patients, as long as they were diagnosed at an early stage and actively treated.
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
T I
TI
Huo
J C
JC
Wu
C R
CR
Lai
C L
CL
Lu
W Y
WY
Sheng
S D
SD
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy / Q000821:virology; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000473:pathology* / Q000628:therapy; D003699:Hepatitis D / Q000150:complications / Q000473:pathology* / Q000628:therapy; D003698:Hepatitis Delta Virus / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015163:Superinfection / Q000150:complications / Q000473:pathology* / Q000628:therapy
D000914:Antibodies, Viral