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J Viral Hepat. 2017 Apr 17. doi: 10.1111/jvh.12717. [Epub ahead of print]
Impact of viral hepatitis etiology on survival outcomes in hepatocellular carcinoma: a large multi-center cohort study.
Mgaieth S1, Kemp W1, Gow P2, Fink M3, Lubel J4, Nicoll A4,5, Gazzola A1, Hong T6, Ryan M6, Knight V7, Dev A7, Sood S5, Bell S6, Paul E8, Roberts SK1.
Author information
1 Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.
2 Department of Gastroenterology, Austin Hospital, Melbourne, Australia.
3 Department of Surgery, Austin Hospital, Heidelberg, Australia.
4 Department of Gastroenterology, Box Hill Hospital, Box Hill, Australia.
5 Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Australia.
6 Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Australia.
7 Department of Gastroenterology, Monash Medical Centre, Clayton, Australia.
8 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Abstract
BACKGROUND AND AIMS:
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 non-viral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes.
METHODS:
We conducted a multi-center study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumor characteristics, and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and non-viral hepatitis cases and predictors of survival determined using Cox proportional hazards regression.
RESULTS:
There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from non-viral causes. The median survival of HBV, HCV and non-viral HCC patients was 59.1, 28.4 and 20.9 months respectively (P<0.0001). On multivariate analysis, independent risk factors for survival included HCC etiology, 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 non-viral (HR 0.60, 95% CI 0.35-0.98; P=0.03) and HCV-related HCC (HR 0.51, 95% CI 0.30-0.85; P=0.01).
CONCLUSIONS:
In this large multicenter study, HBV is independently associated with improved overall survival compared with HCV and non-viral related HCC. Further studies are needed to determine the underlying factor(s) responsible. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Hepatitis B; Hepatitis C; hepatocellular carcinoma; survival
PMID:
28414893
DOI:
10.1111/jvh.12717
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