title: Impact of viral hepatitis on outcomes after liver resection for hepatocellular carcinoma: results from a north american center.
abstract: BACKGROUND
  Hepatitis B (HBV) and hepatitis C (HCV) are well-recognized risk factors for hepatocellular carcinoma (HCC). The characteristics and clinical outcomes of HCC arising from these conditions may differ. This study was conducted to compare the outcomes of HCC associated with HBV and HCV after liver resection.
  
  
  METHODS
  Of 386 liver resections for HCC performed between July 1992 and April 2011, 181 patients had HBV and 74 patients had HCV. Patients with HBV/HCV coinfections (n = 20), non-HBV/HCV etiology (n = 94), and postoperative death within 3 months (n = 17) were excluded. Patient, tumor characteristics, and perioperative and oncologic outcomes were compared between patients with HBV and HCV.
  
  
  RESULTS
  The patients with HBV had better overall survival (OS) than patients with HCV (68 vs. 59 months, p = 0.03); however, there was no difference in recurrence-free survival (RFS) between the groups (44 vs. 45 months, p = 0.1). The factors predictive of OS based on multivariate analyses included: vascular invasion [p < 0.01, hazard ratio (HR) = 3.4], Child-Pugh Score (p < 0.01, HR = 4.8), and underlying liver disease (HCV vs HBV) (p = 0.01, HR = 1.9). Vascular invasion and tumor number (p < 0.01, HR = 2.3 and p < 0.01, HR = 2.1) were independent predictors of RFS.
  
  
  CONCLUSIONS
  OS but not RFS after liver resection for HCC is better in patients with HBV than HCV. This survival advantage for HBV patients may be due to differences in tumor biology and outcomes after disease recurrence.
authors.affiliation: Department of Surgery, 10EN216 Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Jonghun J
authors.initials: JJ
authors.lastname: Lee
authors.forename: Peter T W
authors.initials: PT
authors.lastname: Kim
authors.forename: Sandra
authors.initials: S
authors.lastname: Fischer
authors.forename: Scott
authors.initials: S
authors.lastname: Fung
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Ian
authors.initials: I
authors.lastname: McGilvray
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult