title: Differences in surgical outcomes between hepatitis B- and hepatitis C-related hepatocellular carcinoma: a retrospective analysis of a single North American center.
abstract: OBJECTIVE
  Compare surgical outcomes for hepatitis B virus (HBV)-hepatocellular carcinoma (HCC) versus hepatitis C virus (HCV)-hepatocellular carcinoma (HCC).
  
  
  BACKGROUND
  HCC is the second leading cause of death from cancer worldwide and is associated with hepatitis virus infection in 80% of cases.
  
  
  METHODS
  Between 1997 and 2011, 1008 patients with hepatitis B (HBV, n = 431) or hepatitis C (HCV, n = 577) underwent resection (n = 567) or transplantation (n = 441). Resection was indicated for Child's A patients with single HCC; transplantation was indicated for patients within Milan criteria. Univariate and multivariate analyses were performed as well as survival and recurrence analysis using log-rank test.
  
  
  RESULTS
  Based on uniform application of these criteria, resection: transplantation ratio was 3.6 for patients with HBV and 0.67 for patients with HCV. Resection: Patients with HBV had larger tumors and higher α-fetoprotein but less satellites and macrovascular invasion; 68% of HBV versus 89% of HCV were cirrhotic. Survival was better (P < 0.001) and recurrence was lower (P = 0.009) for HBV. Independent predictors of death included HCV (P = 0.024), transfusion (P = 0.013), and HCC of greater than 5 cm (P = 0.013). Limiting analysis to patients with cirrhosis, survival with HBV remained superior (P = 0.020) but recurrence did not. Transplantation: Tumors were similar in HBV and HCV. Survival was better (P = 0.002) for HBV; recurrence was similar. Independent predictors of death were HCV (P < 0.001), poor differentiation (P = 0.049), vascular invasion (P = 0.002), and outside Milan (P = 0.032). Limiting analysis to patients within Milan, HBV survival remained better for both resection (P = 0.030) and transplantation (P = 0.002).
  
  
  CONCLUSIONS
  Survival after both resection and transplantation for HCC was better in HBV- than in HCV-related HCC whereas recurrence was also lower for HBV-HCC in the resection group, these differences are influenced by both liver and tumor factors.
authors.affiliation: *Liver Cancer Program, Icahn School of Medicine at Mount Sinai, New York, NY †Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY; and ‡Lenox Hill Hospital, New York, NY.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Franssen
authors.forename: Kutaiba
authors.initials: K
authors.lastname: Alshebeeb
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: Josep
authors.initials: J
authors.lastname: Marti
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Pierobon
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins