title: Tumor factors associated with clinical outcomes in patients with hepatitis B virus infection and hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) infection is a common cause of hepatocellular carcinoma (HCC) in the United States. This study evaluated the impact of surveillance and treatment on HBV-infected HCC patients and identified factors associated with survival.
  
  
  METHODS
  From 1981 to 2010, 166 hepatitis B surface antigen (HBsAg)-positive HCC patients were evaluated. Fifty-eight patients had HCC detected by surveillance, while 108 patients presented with HCC.
  
  
  RESULTS
  Compared to patients detected by surveillance, those presenting with HCC had more symptoms (65.7% vs 41.4%; P=.002), were more frequently outside of Milan criteria (73.7% vs 29.6%; P<.001), more often presented with diffuse tumors (23.2% vs 1.9%; P<.001), and had a shortened median survival time (9.5 months vs 18.7 months; P=.003). Patients who presented with diffuse tumors were younger and more often male (P=.002-.007), had a higher alpha-fetoprotein (AFP) level (P=.023), and had a median survival time of only 1.68 months. By multivariate analysis, factors that were significantly associated with mortality included diffuse tumors (hazard ratio [HR], 6.30; 95% confidence interval [CI], 3.14-12.66; P<.001), being outside of Milan criteria (HR, 2.02; 95% CI, 1.26-3.23; P=.005), albumin level (HR per 1 standard deviation decrease, 1.4; 95% CI, 1.15-1.72; P=.001), AFP level (HR per 1 log standard deviation increase, 1.38; 95% CI, 1.13-1.67; P=.001), and receiving liver transplantation versus other treatments (HR, 0.08-0.38; 95% CI, 0.03-0.87; P<.001 to P=.022).
  
  
  CONCLUSIONS
  In the United States, HBV-related HCC is a common malignancy, especially among Asian immigrants. Identification of HBsAgpositive subjects and routine HCC surveillance are essential for improving survival in these patients.
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Myron John
authors.initials: MJ
authors.lastname: Tong
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Surachate
authors.initials: S
authors.lastname: Siripongsakun
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Gaelen
authors.initials: G
authors.lastname: Stanford-Moore
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Leeyen
authors.initials: L
authors.lastname: Hsu
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Patrick Weijen
authors.initials: PW
authors.lastname: Chang
authors.affiliation: Dr. Tong is affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California and with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California. Dr. Siripongsakun is affiliated with the Pfleger Liver Institute and the Division of Digestive Diseases at the David Geffen School of Medicine of the University of California in Los Angeles, California and with Chalubhorn Hospital in Bangkok, Thailand. Ms. Stanford-Moore, Mr. Hsu, and Mr. Chang are affiliated with the Liver Center of Huntington Medical Research Institutes in Pasadena, California. Dr. Blatt is affiliated with Alios Biopharma in South San Francisco, California.
authors.forename: Lawrence Mitchell
authors.initials: LM
authors.lastname: Blatt
keywords: Hepatitis B virus; hepatocellular carcinoma; liver transplantation; locoregional therapy; resection; surveillance; survival