title: Impact of Viral Etiology on Postoperative De Novo Recurrence After Hepatectomy for Hepatocellular Carcinoma in Cirrhotic Patients.
abstract: Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear.
  
  
  
  Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed.
  
  
  
  Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2-5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13-2.13).
  
  
  
  HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. shindou-tky@umin.ac.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.affiliation: Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Nishioka
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Margonis
authors.affiliation: Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Sugawara
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Andreatos
authors.affiliation: Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
authors.forename: Masaji
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000821:virology*; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors
keywords: Hepatectomy; Hepatitis B virus; Hepatitis C virus; Hepatocellular carcinoma; Liver cirrhosis