HBV may lead to more aggressive form of HCC than HCV

CHICAGO — Patients with hepatitis B virus infection were more likely to develop hepatocellular carcinoma at a younger age and have a more aggressive form of the disease vs. patients with hepatitis C virus infection, according to study results presented at the ASCO Annual Meeting.

“Currently, a patient's form of hepatitis is not a factor in treatment planning, but the two types of the virus result in different disease impacts and some variations in outcomes,” Ahmed O. Kaseb, MD, associate professor of gastrointestinal medical oncology at University of Texas MD Anderson Cancer Center, said in a press release. “This study provides more evidence that future clinical trials should stratify patients by hepatitis type to help identify better drugs and create personalized treatment modalities.”

Ahmed O. Kaseb

Kaseb and colleagues analyzed data of 815 patients with HCC treated at MD Anderson between 1992 and 2011, to determine if any “virologic differences” between the two infections influence clinical and pathological features of HCC or patient outcomes. Of the patients, 472 had HCV and 343 had HBV.

“We predicted that HBV and HCV-HCC patients would have much different clinical characteristics and survival outcomes regardless of therapy received in our single-institution cohort,” the researchers wrote.

The researchers found that patients with HBV-associated HCC were more likely to develop HCC at a younger age, have a poorly differentiated tumor which often grows quicker, portal thrombosis, tumor size greater than 5 cm, more than 50% of cancer in the liver, high alpha-fetoprotein and advanced diagnosis stage compared with the HCV patients.

The patients with HCV-associated HCC were more likely to have underlying cirrhosis, a history of greater alcohol and cigarette use and higher co-occurrence of diabetes.

Patients in the HCV group had a higher median survival compared with the HBV group (10.9 vs. 9.3 months; P = .9). One-year survival rates were similar between both groups (43.3%).

“Eligibility for certain treatments depends on cancer staging at diagnosis,” Kaseb said. “Thus, this study has major implications for determining how we treat new HCC patients. Especially for patients with HBV, we need to determine if more aggressive treatment is warranted at the outset.”

The researchers concluded: “Our data and historical data suggest poorer natural history and survival outcomes of HBV-HCC vs. HCV-HCC patients. Our results suggest the need for HCC stratification based on hepatitis status in clinical trials. However, multi-institutional prospective validation studies are warranted.” – by Melinda Stevens

Reference

Uemura MI, et al. Abstract 4011. Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.

Disclosures: Kaseb reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.