title: Influence of hepatitis viruses on clinicopathological profiles and long-term outcome in patients undergoing surgery for hepatocellular carcinoma.
abstract: BACKGROUND
  The global risk of hepatocellular carcinoma (HCC) is largely due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In recent years, however, an increased prevalence of non-viral HCC has been noted. The clinical impact of the presence/absence of viral infections in HCC remains controversial. The present study aimed to assess the effect of hepatitis viruses on demographics, clinical and pathological features and long-term outcome in a large cohort of Romanian patients who underwent surgery for HCC.
  
  
  METHODS
  The study included 404 patients with HCC who had undergone resection, transplantation or radiofrequency ablation at a single institution between 2001 and 2010. The patients were divided into four groups: 85 patients with hepatitis B virus infection (HBV group), 164 patients with hepatitis C virus infection (HCV group), 39 patients with hepatitis B and C virus co-infection (HBCV group), and 116 patients without viral infection (non-BC group).
  
  
  RESULTS
  The patients of both HBV (56.0+/-11.3 years) and HBCV groups (56.0+/-9.9 years) were significantly younger than those of the HCV (61.0+/-8.5 years, P=0.001) and non-BC groups (61.0+/-13.0 years, P=0.002). Interestingly, the prevalence of liver cirrhosis was significantly lower in the non-BC group (47%) than in any other subsets (72%-90%, P<0.002). Furthermore, the non-BC patients were more advanced according to the Barcelona Clinic Liver Cancer stages than the patients of the HCV or HBCV groups (P<0.020); accordingly, they were more frequently assessed beyond the Milan criteria than any other groups (P=0.001). No significant differences in the disease-free or overall survival rates were observed among these groups.
  
  
  CONCLUSIONS
  Patients with non-viral HCC are diagnosed at advanced ages and stages, a situation plausibly due to the poor effectiveness of cancer surveillance in community practice. The presence of viral infections does not appear to impair the long-term prognosis after surgical treatment in patients with HCC; however, there is a trend for worse disease-free survival rates in HBCV patients, though statistical significance was not reached.
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street No. 258, 022328, Bucharest, Romania. irinel.popescu220@gmail.com.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Tanase
authors.forename: Traian
authors.initials: T
authors.lastname: Dumitrascu
authors.forename: Simona
authors.initials: S
authors.lastname: Dima
authors.forename: Razvan
authors.initials: R
authors.lastname: Grigorie
authors.forename: Agnes
authors.initials: A
authors.lastname: Marchio
authors.forename: Pascal
authors.initials: P
authors.lastname: Pineau
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome