title: Hepatocellular carcinoma in hepatitis D: does it differ from hepatitis B monoinfection?
abstract: OBJECTIVE
  Hepatitis D virus (HDV) superinfection in patients with chronic hepatitis B leads to accelerated liver injury, early cirrhosis, and decompensation. It may be speculated that hepatocellular carcinoma (HCC) may differ in these patients from hepatitis B virus (HBV) monoinfection. The aim of this study was to compare clinical aspects of hepatocellular carcinoma in patients of hepatitis D with HBV monoinfection.
  
  
  METHODS
  A total of 92 consecutive HCC cases seropositive for antibody against HDV antigen (HDV group) were compared with 92 HBsAg-positive and anti-HDV-negative cases (HBV group).
  
  
  RESULTS
  The features including sex, body mass index, presence of ascites, serum biochemistry, gross tumor appearance, child class, barcelona cancer liver clinic and okuda stages were not significantly different between the 2 groups. Decreased liver size was noticed more in cases of HDV compared with HBV group where the liver size was normal or increased (P=0.000). HDV patients had lower platelets (P=0.053) and larger varices on endoscopy (P=0.004). Multifocal tumors and elevated alpha-fetoprotein level >1000 IU/mL were more common in HBV group (P=0.040 and P= 0.061). TNM classification showed more stage III-IV disease in HBV group (P=0.000).
  
  
  CONCLUSIONS
  Decreased liver size and indirect evidence of more severe portal hypertension and earlier TNM stage compared with HBV monoinfection indicate that HDV infection causes HCC in a different way, possibly indirectly by inducing inflammation and cirrhosis.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan. zaigham.abbas@aku.edu
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Qureshi
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000821:virology*; D016009:Chi-Square Distribution; D004724:Endoscopy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D003699:Hepatitis D / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000821:virology; D015994:Incidence; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011859:Radiography; D018709:Statistics, Nonparametric; D014463:Ultrasonography