Skip to main content
SpringerLink
Log in

Comparison of Surgical Outcomes for Hepatocellular Carcinoma in Patients With Hepatitis B Versus Hepatitis C: A Western Experience

  • Editorial
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: We reviewed our experience in patients with hepatocellular carcinoma (HCC) and chronic hepatitis to determine if differences exist in preoperative status and postoperative survival between those with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.

Methods: We reviewed the records of 240 consecutive patients with HCC who underwent hepatic resection or liver transplantation at Mount Sinai Hospital between February 1990 and February 1998. Patients who tested negative for hepatitis B antigen and hepatitis C antibody (74 patients) as well as those who tested positive for both (2 patients) were excluded. Age as well as preoperative platelet count, prothrombin time (PT), albumin, and total bilirubin were measured in all patients. The presence of encephalopathy or ascites also was noted. Explanted livers and resection specimens were examined for size, number, and differentiation of tumors as well as the presence of vascular invasion and cirrhosis in the surrounding parenchyma.

Results: One hundred twenty-one patients with HCC tested positive for HCV, and 43 tested positive for HBV. A significantly higher proportion of patients with HCV required transplant for the treatment of their HCC when compared to those with HBV. In the resection group, patients with HCV were significantly older that those with HBV. They also had significantly lower mean preoperative platelet counts and albumin levels and higher mean PT and total bilirubin levels. Resected patients with HCV had significantly less-differentiated tumors and a higher incidence of vascular invasion and cirrhosis when compared to those with HBV. There was no statistical difference in the multicentricity and size of tumors between the two groups. The 5-year disease-free survival was significantly higher for HBV patients treated with resection when compared to those with HCV (49% vs. 7%, P 5 .0480). Patients with HCC and HCV had significantly longer 5-year disease-free survival with transplant when compared to resection (48% vs. 7%, P 5 .0001).Transplanted patients with HBV and HCC had preoperative status, pathological findings, and survival similar to those of patients with HCV.

Conclusions: Based on preoperative liver function and tumor location, a much higher proportion of HCC patients with HBV were candidates for resection. Significant differences in preoperative status, tumor characteristics and disease-free survival exist between HCC patients with chronic HBV and HCV infection who have not yet reached end-stage liver disease. Serious consideration should be given to transplanting resectable HCC with concomitant HCV, especially in cases with small tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Szmuness W. Hepatocellular carcinoma and the hepatitis B virus: evidence for a causal relationship. Prog Med Virol 1978;24:40–69.

    Google Scholar 

  2. Beasley RP, Hwang LY. Overview on the epidemiology of hepatocellular carcinoma. In: Hollinger FB, Lemon SM, Margolis HS, eds. Viral hepatitis and liver disease. Baltimore: Williams & Wilkins, 1990:532–535.

    Google Scholar 

  3. Lu SN, Lin TM, Chen CJ, et al. A case-control study of primary hepatocellular carcinoma in Taiwan. Cancer 1988;62:2051–2055.

    Google Scholar 

  4. Sallie R, DiBisceglie AM. Viral hepatitis and hepatocellular carcinoma. Gastroenterol Clin North Am 1994;23:567–79.

    Google Scholar 

  5. Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus: a prospective study of 27707 men in Taiwan. Lancet 1981;2:1129–1133.

    Google Scholar 

  6. Liaw YF, Tai DI, Chu CM, et al. Early detection of hepatocellular carcinoma in patients with chronic type B hepatitis: A prospective study. Gastroenterology 1986;90:263–267.

    Google Scholar 

  7. Choo QL, Kuo G, Weiner AJ, et al. Isolation of cDNA clone derived from blood-borne non-A, non-B virus hepatitis genome. Science 1989;244:359–362.

    CAS  PubMed  Google Scholar 

  8. Kuo G, Choo QL, Alter HJ, et al. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 1989;244:362–364.

    CAS  PubMed  Google Scholar 

  9. Tsukuma H, Hiyama T, Tanaka S, et al. Risk factors for hepatocellular carcinoma among patients with chronic liver disease. N Engl J Med 1993;328:1797–1801.

    Google Scholar 

  10. Saito I, Miyamura T, Ohbayashi A, et al. Hepatitis C virus infection is associated with the development of hepatocellular carcinoma. Proc Natl Acad Sci U S A 1990;87:6547–6549.

    Google Scholar 

  11. Nishioka K, Wantanabe J, Furuta S, et al. A high prevalence of antibody to hepatitis C virus in patients with hepatocellular carcinoma in Japan. Cancer 1991;67:429–433.

    CAS  PubMed  Google Scholar 

  12. Ohkoshi S, Kato N, Kinoshita T, et al. Detection of hepatitis C virus RNA in sera and liver tissue of non-A, non-B hepatitis patients using the polymerase chain reaction. Jpn J Cancer Res 1990;81:862–865.

    Google Scholar 

  13. Bruix J, Barrera JM, Calvet X, et al. Prevalence of antibodies to hepatitis C virus in Spanish patients with hepatocellular carcinoma and hepatic cirrhosis. Lancet 1989;2:1004–1006.

    Google Scholar 

  14. Ruiz J, Sangro B, Cuenda JI, et al. Hepatitis B and C viral infections in patients with hepatocellular carcinoma. Hepatology 1992;16:637–641.

    Google Scholar 

  15. Colombo M, Kuo G, Choo QL, et al. Prevalence of antibodies to hepatitis C virus in Italian patients with hepatocellular carcinoma. Lancet 1989;2:1006–1008.

    Google Scholar 

  16. Hasan F, Jeffers LJ, De Medina M, et al. Hepatitis C associated hepatocellular carcinoma. Hepatology 1990;12:589–591.

    Google Scholar 

  17. Liang TJ, Jeffers L, Reddy KR, et al. Viral pathogenesis of hepatocellular carcinoma in the United States. Hepatology 1993;18:1326–1333.

    Google Scholar 

  18. Diamantis ID, McGandy CE, Chen TJ, et al. The integration state of hepatitis B virus in hepatocellular carcinoma. J Virol Dis 1993;1:9–15.

    Google Scholar 

  19. Yaginuma K, Kobayashi H, Kobayashi M, et al. Multiple integration sites of hepatitis B virus DNA in hepatocellular carcinoma and chronic active hepatitis tissues from children. J Virol 1987;61:1808–1813.

    Google Scholar 

  20. Rogler CE, Sherman M, Su CY, et al. Deletion in chromosome 11p associated with a hepatitis B integration site in hepatocellular carcinoma. Science 1985;230:319–322.

    Google Scholar 

  21. Hino H, Shows TB, Rogler CB. Hepatitis B virus integration site in hepatocellular carcinoma at chromosome 17;18 translocation. Proc Natl Acad Sci U S A 1986;83:8338–8342.

    Google Scholar 

  22. Rogler CE. Cellular and molecular mechanisms of hepatocarcinogenesis associated with hepadenavirus infection. Curr Top Microb Immunol 1991;168:103–140.

    Google Scholar 

  23. Robinson WS. The role of hepatitis B virus in the development of primary hepatocellular carcinoma. J Gastroenterol Hepatol 1992;7:622–38 and 1993;8:95–106.

    Google Scholar 

  24. Shiratori Y, Shiina S, Imamura M, et al. Characteristic differences of hepatocellular carcinoma between hepatitis B- and C- viral infections in Japan. Hepatology 1995;22:1027–33.

    Article  CAS  PubMed  Google Scholar 

  25. Takenaka K, Yamamoto K, Taketomi A, et al. A comparison of surgical results in patients with hepatitis B versus hepatitis Crelated hepatocellular carcinoma. Hepatology 1995;22:20–24.

    Google Scholar 

  26. Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B and hepatitis C viral infections: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 1996;24:307–310.

    Google Scholar 

  27. Tanizaki H, Ryu M, Kinoshita T, et al. Comparison of clinical features and survival in patients with hepatitis B and C virusrelated hepatocellular carcinoma. Jpn J Clin Oncol 1997;27:67–70.

    Google Scholar 

  28. Yamanaka N, Tanaka T, Tanaka W, et al. Correlation of hepatitis virus serologic status with clinicopathologic features in patients undergoing hepatectomy for hepatocellular carcinoma. Cancer 1997;79:1509–1515.

    Google Scholar 

  29. Chung SW, Toth JL, Rezieg M, et al. Liver transplantation for hepatocellular carcinoma. Am J Surg 1994;167:317–321.

    Google Scholar 

  30. Wong PY, McPeake JR, Portmann B, et al. Clinical course and survival after liver transplantation for hepatitis B virus infection complicated by hepatocellular carcinoma. Am J Gastroenterol 1995;90:29–34.

    Google Scholar 

  31. Tiollais P, Hsu TY, Moroy T, et al. Hepadenavirus as an insertional mutagen in hepatocellular carcinoma. In: Hollinger FB, Lemon SM, Margolis HS, eds. Viral hepatitis and liver disease. Baltimore:Williams & Wilkins, 1990:541–546.

    Google Scholar 

  32. Wang XW, Forrester K, Yeh H, et al. Hepatitis B virus X protein inhibits p53 sequence-specific DNA binding, transcriptional activity and association with transcription factor ERCC3. Proc Natl Acad Sci U S A 1994;91:2230–2234.

    Google Scholar 

  33. Truant R, Antunovic J, Greenblatt J, et al. Direct interaction of the hepatitis B virus HBX protein with p53 leads to inhibition by HBX of p53 response element-directed transactivation. J Virol 1995;69:1107–1114.

    Google Scholar 

  34. Castells L, Vargas V, Gonzalez A, et al. Long interval between HCV infection and development of hepatocellular carcinoma. Liver 1995;15:159–163.

    Google Scholar 

  35. Tchervenkov JI, Tector AJ, Barkun JS, et al. Recurrence-free long-term survival after liver transplantation for hepatitis B using interferon-alpha pretransplant and hepatitis B immune globulin posttransplant. Ann Surg 1997;226:356–338.

    Article  CAS  PubMed  Google Scholar 

  36. Gugenheim J, Baldini E, Ouzan D, Mouiel J. Absence of initial viral replication and long-term high dose immunoglobulin administration improve results of hepatitis B virus recurrence prophylaxis after liver transplantation. Transplant Proc 1997;29:517–518.

    Google Scholar 

  37. Nyman T, Shokouh-Amir MH, Vera SR, et al. Prevention of hepatitis B recurrence with indefinite hepatitis B immune globulin (HBIG) prophylaxis after liver transplantation. Clin Transplant 1996;10:663–667.

    CAS  PubMed  Google Scholar 

  38. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–699.

    Article  Google Scholar 

  39. Pichlmayr R, Weimann A, Oldhafer KJ, et al. Appraisal of transplantation for malignant tumors of the liver with special reference to early stage hepatocellular carcinoma. Eur J Surg Onc 1998;24:60–67.

    Google Scholar 

  40. Tan KC, Rela M, Ryder SD, et al. Experience of orthotopic liver transplantation and hepatic resection for hepatocellular carcinoma of less than 8 cm in patients with cirrhosis. Br J Surg 1995;82:253–256.

    Google Scholar 

  41. Bismuth H, Chiche L, Adam R, et al. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145–151.

    Google Scholar 

  42. Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221–229.

    Google Scholar 

  43. Otto G, Heuschen U, Hofmann WJ, et al. Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis. Ann Surg 1998;227:424–432.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Recanati-Miller Transplantation Institute, Mount Sinai Medical Center, 19 East 98th Street, Suite 6F, New York, NY, 10029

    Sasan Roayaie MD, Menahem Ben Haim MD, Sukru Emre MD, Thomas M. Fishbein MD, Patricia A. Sheiner MD, Charles M. Miller MD & Myron E. Schwartz MD

Authors
  1. Sasan Roayaie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Menahem Ben Haim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sukru Emre MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas M. Fishbein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patricia A. Sheiner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles M. Miller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Myron E. Schwartz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myron E. Schwartz MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roayaie, S., Haim, M.B., Emre, S. et al. Comparison of Surgical Outcomes for Hepatocellular Carcinoma in Patients With Hepatitis B Versus Hepatitis C: A Western Experience. Ann Surg Oncol 7, 764–770 (2000). https://doi.org/10.1007/s10434-000-0764-8

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-000-0764-8

Key Words

Search

Navigation