Influence of viral hepatitis status on prognosis in patients undergoing hepatic resection for hepatocellular carcinoma: a meta-analysis of observational studies

Abstract

BackgroundThe influence of viral hepatitis status on prognosis in patients undergoing hepatic resection for hepatocellular carcinoma (HCC) remains a matter of debate. This study is a meta-analysis of the available evidence.MethodsA literature search was performed to identify comparative studies reporting postoperative survival of HCC in different types of viral hepatitis. Pooled odds ratios (OR) and weighted mean differences (WMD with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.ResultsTwenty studies matched the selection criteria and reported on 4744 subjects, of whom 2008 in the HBV-positive (B-HCC) group, 2222 in the HCV-positive (C-HCC) group, and 514 in the hepatitis B- and C-negative (NBNC-HCC). Meta-analysis showed that patients with HBV or HCV infection had a worse 5-year disease-free survival when compared to patients with NBNC-HCC (respectively: OR: 0.39, 95% CI: 0.28 to 0.53, P < 0.001; WMD: 0.37, 95% CI: 0.22 to 0.64, P < 0.001). There was a tendency toward higher 5-year overall survival rates in the NBNC-HCC group compared to those in the other two groups, although these differences were not statistically significant. Both the 5-year overall survival and disease-free survival were not different among the B-HCC and C-HCC groups.ConclusionsPatients with positive serology for hepatitis B or C undergoing resection for HCC had a poor prognosis compared to patients with negative serology.

Role of aetiology, diabetes, tobacco smoking and hypertension in hepatocellular carcinoma survival

“…HBV-infected patients with HCC had more severe liver disease and more advanced cancer than HCV-infected patients, however no statistically significant advantage in survival was found, in agreement with most [8,10,[31][32][33][34], although not all [35-38], previous studies. Differences in the epidemiological pattern and treatment of HBV and HCV, and in their surveillance programs, may help explain these discrepancies.…”

“…Patients with alcohol-related HCC had a higher T stage, greater tumour diameter and a worse prognosis than virus-related cancer, if the analysis was restricted to patients undergoing treatment or in stage pT 1-2. Delayed HCC diagnosis may explain the worse prognosis in patients with alcohol-related liver disease compared to subjects with HBV/HCV infection, as the former are included less often in surveillance programs than the latter [8,29].…”

“…The role of these factors in clinical presentation at diagnosis and survival after therapy has been widely investigated, but conflicting results have been reported so far [5][6][7][8][9][10].…”

Efficacy and Safety of the FOLFOX4 Regimen Versus Doxorubicin in Chinese Patients With Advanced Hepatocellular Carcinoma: A Subgroup Analysis of the EACH Study

“…This lower median OS in the Chinese patients can probably be attributed to the higher proportion of patients with a history of HBV infection at baseline in these patients (the vast majority of Chinese patients had a history of HBV infection) than in the EACH study overall (95.34% vs. 91.37%) or in the non-Chinese population (89.1% had HBC or HCV infection at baseline). Although the prognostic significance of viral etiology in the treatment of advanced HCC is unclear, it remains a potential key factor influencing the clinical manifestation, treatment, and progression of HCC [30,31].…”

Disparities in Time to Treatment of Hepatocellular Carcinoma in Patients with Hepatitis B Virus versus Hepatitis C Virus

“…In a case-control study examining HBV and HCV related HCC where patients were matched based on age, gender, location of treatment, Child Pugh score and tumor stage, no statistical difference in survival was observed [10,26].…”