Chronic viral hepatitis and hepatocellular carcinoma.
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.
Barazani
Yagil
Y
Dumont-UCLA Liver Cancer Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
Hiatt
Jonathan R
JR
Tong
Myron J
MJ
Busuttil
Ronald W
RW
D000328:Adult; D000368:Aged; D002140:California; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate