title: Effects of Cirrhosis on Short-term and Long-term Survival of Patients With Hepatitis B-related Hepatocellular Carcinoma.
abstract: Hepatitis B virus (HBV) is the most common cause of hepatocellular carcinoma (HCC) worldwide. Unlike other liver diseases, HBV can cause HCC in the absence of cirrhosis. We investigated whether features of HCC in patients with HBV infection without cirrhosis and survival times differ from those of patients who develop HCC after cirrhosis.
  
  
  
  We performed a retrospective cohort study of 487 consecutive cases of HBV-related HCC who were seen from 2000 through 2014 at a tertiary care center. Laboratory values, imaging results, and treatment information were obtained from subjects' medical records. Symptoms of HCC included weight loss, abdominal pain, or new hepatic decompensation. The primary outcome was overall survival, which was categorized as short-term survival (up to 3 years after the diagnosis of HCC) or long-term survival (3-10 years after diagnosis).
  
  
  
  The mean tumor size at diagnosis was significantly larger in patients without cirrhosis (6.4 ± 4.3 cm) than in patients with cirrhosis (5.0 ± 3.8 cm) (P = .0009). A significantly larger proportion of patients without cirrhosis had symptoms at diagnosis (43.8% vs 35.4% in patients without cirrhosis, P = .09). A significantly higher proportion of patients without cirrhosis survived for the long-term (P = .003), but there was no significant difference between groups in short-term survival (P = .37). Notably, the same proportions of asymptomatic patients with and without cirrhosis survived for the short-term (64.3% vs 64.2%, P = .73), but a lower proportion of asymptomatic patients with cirrhosis survived for the long-term (P = .015). In multivariate Cox regression analysis, cirrhosis was an independent predictor of death in 3-10 years (hazard ratio, 3.76; P = .003) but not in less than 3 years (P = .48). Symptoms at diagnosis predicted death within 3 years (hazard ratio, 1.76; P =.006) but not in 3-10 years (P = .15).
  
  
  
  Patients with HBV infection and HCC without cirrhosis present with larger tumors, and a larger percentage have symptoms of cancer than patients with cirrhosis. This may indicate that HCC surveillance is less than optimal for patients with HBV infection without cirrhosis. Despite this suboptimal surveillance, patients without cirrhosis have higher long-term survival than those with cirrhosis, especially when asymptomatic at diagnosis.
authors.affiliation: Department of Medicine, Stanford University Medical Center, Palo Alto, California.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
authors.forename: An K
authors.initials: AK
authors.lastname: Le
authors.affiliation: School of Medicine, Stanford University, Stanford, California.
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; School of Medicine, Stanford University, Stanford, California.
authors.forename: Lily H
authors.initials: LH
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of California in San Diego, San Diego, California.
authors.forename: Nghia H
authors.initials: NH
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
authors.forename: Pauline P
authors.initials: PP
authors.lastname: Nguyen
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, P.R.C.
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California. Electronic address: mindiehn@stanford.edu.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Carcinogenesis; Liver Cancer; Mortality; Progression