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Substantial pathological differences between HCC patients with HBV, HCV

Patients with hepatocellular carcinoma associated with hepatitis B may be more prone to early onset of cancer and poor prognosis than patients with carcinomas associated with hepatitis C, according to recent results that also indicated several other clinical-pathologic differences between the two.

Researchers evaluated data from 127 patients with HBV (n=89) or HCV (n=38) who also were diagnosed with associated hepatocellular carcinoma (HCC) at Bellevue Hospital Center in New York from 1993 to 2005. Other incorporated factors included demographics, the presence of cirrhosis, the number and size of tumors, alpha-fetoprotein (AFP) serum levels and eligibility for curative treatment.

Onset of HCC at a younger age was more common among patients with HBV than patients with HCV, with 26% of HBV patients aged 40 years and younger compared with 0% of HCV patients (P<.001). Higher levels of serum AFP also were significantly more common in HBV patients, with a median level of 1,000 ng/mL vs. 37 ng/mL in patients with HCV (P=.002), although similar proportions existed in the two groups of patients producing normal serum levels.

Larger tumors were more common in HBV patients, with 78% of participants having tumors with a cross-sectional diameter larger than 5 cm, compared with 28% in the HCV group (P<.001), and HBV patients also were significantly less likely to be eligible for liver transplant and surgical resection (14% of patients eligible compared with 34% of HCV patients, P<.05).

Patients with HCV were more likely to develop cirrhosis (100% of HCV patients compared with 60% of HBV patients), and also were more prone to multiple systemic comorbidities (mean 2.9 ± 1.5 comorbidities per patient compared with 1.0 ± 1.1 among HBV patients, P<.001). History of alcohol abuse was more common among patients with HCV (32% of patients compared with 7% of those with HBV, P<.001), as was coinfection with HIV (13% vs. 1%, P<.001).

“These data suggest a role for more aggressive screening and management of chronic HBV patients,” the researchers concluded, “particularly those subjected to maternal-fetal viral transmission. The importance of earlier screening and more aggressive treatment is especially emphasized by the advanced oncologic nature of HCC associated with HBV on typical initial diagnosis.”