title: Characteristics and outcome of patients with dual hepatitis B and C-associated hepatocellular carcinoma: are they different from patients with single virus infection?
abstract: BACKGROUND
  Patients with hepatocellular carcinoma (HCC) caused by dual hepatitis B and C virus (HBV, HCV) infection may constitute a distinct disease group that is different from patients with single virus infection. This study compared the clinical characteristics and outcomes of patients with HBV, HCV and dual virus infection.
  
  
  METHODS
  A prospective database of 1215 HCC patients with chronic hepatitis B, C or dual virus infection was investigated.
  
  
  RESULTS
  Patients with HCV infection (n=388) were significantly older (mean age, 69 years) than patients with dual virus (n=75, 65 years) and HBV (n=752; 60 years) infection (P<0.0001). The male-to-female ratios for the HBV, dual virus and HCV groups were 5.2, 3.4 and 1.3 respectively (P<0.0001). Patients in the HBV group more often had higher total tumour volume (mean, 409 cm(3)) than those in the dual virus group (244 cm(3)) and HCV (168 cm(3)) group (P<0.0001). No significant differences of the severity of liver cirrhosis, performance status, cancer staging and tumour cell differentiation were noted among the three groups. Patients in the HCV group had a significantly poor survival in comparison with the HBV group only in the subset of patients with small tumour volume (<50 cm(3)) in the Cox proportional hazards model (relative risk, 1.44; P=0.041).
  
  
  CONCLUSIONS
  Dual HBV and HCV virus infection does not accelerate the speed of HCC formation in patients with chronic hepatitis B, and appears to have a modified course of carcinogenesis pathway that is diverted away from the biological behaviour of HBV and HCV infection.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Loong
authors.forename: Jen-Huei
authors.initials: JH
authors.lastname: Chiang
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013624:Taiwan