Hepatology International

, Volume 7, Issue 2, pp 645–654

Alcoholism worsens the survival of patients with hepatitis B virus and C virus-related hepatocellular carcinoma

  • Yun-Hsuan Lee
  • Chia-Yang Hsu
  • Cheng-Yuan Hsia
  • Yi-Hsiang Huang
  • Chien-Wei Su
  • Yi-You Chiou
  • Han-Chieh Lin
  • Teh-Ia Huo
  • Shou-Dong Lee
Original Article

DOI: 10.1007/s12072-012-9375-2

Cite this article as:
Lee, Y., Hsu, C., Hsia, C. et al. Hepatol Int (2013) 7: 645. doi:10.1007/s12072-012-9375-2

Abstract

Background/Aims

Chronic hepatitis B and hepatitis C virus (HBV, HCV) infection and alcoholism are common etiologies for hepatocellular carcinoma (HCC). The characteristics and impact of alcoholism and/or HCV/HBV infection on HBV- and HCV-related HCC, respectively, are investigated in this study.

Methods

A total of 1,888 patients were retrospectively investigated and categorized into six groups, HBV only (n = 977), HBV with alcoholism (n = 197), HCV only (n = 544), HCV with alcoholism (n = 67), dual HBV and HCV (n = 82), and dual virus with alcoholism (n = 21), to examine their interactions on the outcome.

Results

Compared to their counterparts, alcoholic patients coinfected with HBV and/or HCV tended to be younger, had higher male-to-female ratios, worse performance status, more severe liver cirrhosis, advanced cancer staging, and tumor burden than patients without alcoholism. In survival analysis, patients with HBV with alcoholism had a significantly decreased survival than the HBV-only group (p = 0.001). A shortened survival was also observed in HCV with alcoholism group compared to the HCV-only group (p = 0.011). Dual virus infection with alcoholism did not significantly worsen the survival compared to the dual virus infection group. In the Cox proportional hazards model, HBV with alcoholism group [risk ratio (RR) 1.299, p = 0.032] and HCV with alcoholism (RR 1.523, p = 0.025) group were independent predictors associated with decreased survival compared to their counterpart of HBV- and HCV-only groups.

Conclusions

Alcoholism in patients with HBV or HCV infection is characterized by early development of HCC with advanced cirrhosis and cancer staging at diagnosis. Alcoholism independently predicts an increased risk of mortality in patients with HBV- and HCV-related HCC.

Keywords

AlcoholismDual virus infectionHBVHCVHepatocellular carcinoma

Abbreviations

AFP

α-Fetoprotein

Anti-HCV

Antibody against HCV

BCLC

Barcelona Clinic Liver Cancer

CLIP

Cancer of the Liver Italian Program

CT

Computed tomography

CTP

Child–Turcotte–Pugh

ECOG

Eastern Cooperative Oncology Group

HBsAg

Hepatitis B surface antigen

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

INR

International normalized ratio

MELD

Model for end-stage liver disease

MRI

Magnetic resonance imaging

TACE

Transarterial chemoembolization

TTV

Total tumor volume

Copyright information

© Asian Pacific Association for the Study of the Liver 2012

Authors and Affiliations

  • Yun-Hsuan Lee
    • 1
    • 4
  • Chia-Yang Hsu
    • 1
    • 4
  • Cheng-Yuan Hsia
    • 2
    • 4
  • Yi-Hsiang Huang
    • 1
    • 5
  • Chien-Wei Su
    • 1
    • 4
  • Yi-You Chiou
    • 3
    • 4
  • Han-Chieh Lin
    • 1
    • 4
  • Teh-Ia Huo
    • 1
    • 6
  • Shou-Dong Lee
    • 4
    • 7
  1. 1.Division of Gastroenterology, Department of MedicineTaipei Veterans General Hospital, National Yang-Ming University School of MedicineTaipeiTaiwan
  2. 2.Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Faculty of MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  5. 5.Institute of Clinical MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  6. 6.Institute of PharmacologyNational Yang-Ming University School of MedicineTaipeiTaiwan
  7. 7.Cheng Hsin General HospitalTaipeiTaiwan