Clinical outcomes of a cohort series of patients with hepatocellular carcinoma in a hepatitis <scp>B</scp> virus‐endemic area

Kwak, Heewon; Park, Joong-Won; Nam, Byung–Ho; Yu, Ami; Woo, Sang Myung; Kim, Tae Hyun; Kim, Seong Hoon; Lee, Kyung-Hun; Kim, Hyun Beom; Park, Sang Jae; Lee, Woojin; Hong, Eun Kyung; Kim, In Soo

doi:10.1111/jgh.12470

Cited by 47 publications

(67 citation statements)

References 26 publications

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“…who found in multivariate analysis of 1148 cases that HBV infection was associated with significantly improved survival compared to HCV‐related HCC. However, results across studies are not uniform with others finding no difference in survival between HBV‐related HCC and other aetiologies, and/or that HBV is not an independent predictor of survival . In addition, other studies have suggested that the influence of HBV on outcome is dependent on tumour stage, reporting that HBV has no influence on survival in earlier stage HCC, but a negative survival impact in later stage disease .…”

Section: Discussionmentioning

confidence: 78%

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

Mgaieth

Kemp

Gow

et al. 2017

Journal of Viral Hepatitis

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While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.

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Section: Discussionmentioning

confidence: 78%

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

Mgaieth

Kemp

Gow

et al. 2017

Journal of Viral Hepatitis

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“…However, when we excluded patients with portal vein invasion, we still found that the survival of HCC patients with bile duct invasion was poor. Even in early HCC such as BCLC stages A or B, the medial survival of patients with bile duct invasion was markedly shorter than that of those without bile duct invasion described in the prior study (11.6 vs. 32.5 months) [29]. When all the results are combined, bile duct invasion itself seems to be a prognostic factor for poor survival in HCC patients.…”

Section: Discussionmentioning

confidence: 81%

Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion

et al. 2017

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Background/AimsLittle is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion.MethodsA total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included.ResultsThe majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively).ConclusionsThe survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.

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“…Second, patient histories of alcohol consumption were obtained through self-reporting, which may not be reliable. It is possible that the proportion of patients who had alcoholic liver disease as the cause of HCC was underestimated [25], and this underestimation could have affected the observed clinical features of the population classified as cHCC. Third, metabolic factors resulting from the metabolic syndrome were not clearly implicated as the main cause of cHCC in this study.…”

Section: Discussionmentioning

confidence: 99%

“…A cohort of 1,972 patients newly diagnosed with HCC and treated at the National Cancer Center hospital, Korea, between January 2004 and December 2009 was investigated for this study [25]. The patients were enrolled prospectively, and relevant clinical data and tumor characteristics were extracted retrospectively from their medical records.…”

Section: Patients and Classification Of Hcc According To Causementioning

confidence: 99%

Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area

et al. 2015

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Objectives: Chronic hepatitis B virus (HBV) infection is the most common cause of hepatocellular carcinoma (HCC) in South Korea, but a high prevalence of metabolic diseases may result in increases in the incidence of cryptogenic HCC (cHCC). We studied characteristics of the cHCC in a single-center cohort. Methods: A cohort of 1,784 HCC patients newly diagnosed and treated at the National Cancer Center, Korea, between 2004 and 2009 was reviewed and analyzed. Results: The cause of HCC was categorized as cHCC, HBV, hepatitis C virus (HCV), or alcohol. Overall, 162 (9.1%) patients of the HCC cohort had cHCC, and their mean age was 61.9 years. The median survival of cHCC patients was 24.7 months, which was the second shortest among the four groups after HBV HCC. cHCC patients had the largest tumor size (mean 7.4 cm) and the second highest proportion of poor prognostic factors such as the proportion of poorly defined tumors and extrahepatic spread in imaging studies. cHCC patients had better survival than HBV HCC patients according to multivariate analysis. Among cHCC patients, 137 (84.6%) had anti-HBc IgG antibodies, but this sub-group had different clinical features to those of HBV HCC patients. The body mass index (BMI) and hyperglycemia and hypercholesterolemia levels in cHCC patients were similar to those in HCV and alcoholic HCC patients. Conclusions: Anti-HBc IgG antibodies were present in most cHCC patients, but cHCC patients had better survival than HBV HCC patients on multivariate analysis. However, cHCC patients had a larger mean tumor size and more aggressive tumor characteristics than HCV HCC or alcoholic HCC patients did. It is hoped that this study will contribute to a better understanding of cHCC in HBV-endemic areas.

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Clinical outcomes of a cohort series of patients with hepatocellular carcinoma in a hepatitis B virus‐endemic area

Abstract: This cohort study provides valuable insights into the characteristics of HCC in Korean patients. Our findings may help develop clinical trials, treatment strategies, and prognosis systems for HCC patients in HBV-endemic areas.

Cited by 47 publications

References 26 publications

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

Clinical features and outcomes of patients with hepatocellular carcinoma complicated with bile duct invasion

Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area

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