Differences in Surgical Outcomes Between Hepatitis B (HBV)- and Hepatitis C (HCV)-related Hepatocellular Carcinoma (HCC)
Bernardo Franssen*, Kutaiba Alshebeeb*, Sasan Roayaie*, Parissa Tabrizian*, Nir Lubezky*, Myron Schwartz, Sander Florman*
Icahn School of Medicine at Mount Sinai, New York, NY
OBJECTIVE(S): Compare HBV vs HCV-HCC surgical outcomes.
METHODS: Between 1997-2011, 1008 patients with HBV (n=431) or HCV (n=577) underwent resection (n=567) or transplantation (n-441). Resection was indicated for Child’s A patients without portal hypertension and with single HCC. Based on uniform application of these criteria, resection:transplant ratio was 3.6 for HBV and .67 for HCV.
RESULTS: Resection- HBV had larger tumors and higher AFP, but less satellites and macroVI; 68% of HBV vs 89% of HCV were cirrhotic. Survival was better (p<.001) and recurrence lower (p=.009) for HBV. Independent predictors of death included HCV (p=0.024), transfusion (p=0.013), and HCC>5cm (p=0.013). Limiting analysis to cirrhotics, survival with HBV remained superior (p=.02). Transplant- Tumors were similar in HBV and HCV. Survival was better (p=.002) for HBV; recurrence was similar. Independent predictors of death were HCV (p=.01), poor differentiation (p=0.013), vascular invasion (p=0.013), and outside Milan (p=0.013). Limiting analysis to patients within Milan, HBV survival remained better for both resection (p=.03) and transplant (p=.002).
CONCLUSIONS: In a single US center and with identical selection criteria, results of both resection and transplantation are better with HBV than HCV. This reflects the ease of antiviral treatment for HBV, and likely differences in tumor biology.
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