Comparison of clinical manifestations and outcomes between hepatitis B virus- and hepatitis C virus-related hepatocellular carcinoma: analysis of a nationwide cohort

Abstract

Background: We analyzed whether difference exist in the clinical manifestations and outcomes of hepatocellular carcinoma (HCC) according to the two major etiologies of HCC from a nationwide, population-based, random HCC registry.

Methods: Of the 31,521 new HCC cases registered at the Korea Central Cancer Registry between 2003 and 2005, 4,630 (14.7%) were randomly abstracted, and followed up until December 2011. Of those, 2,785 hepatitis B virus (HBV)-related and 447 hepatitis C virus (HCV)-related HCC patients were compared.

Results: The mean annual incidence rates of HBV- and HCV-related HCC incidence per 100,000 persons were 20.8 and 4.9, respectively. The annual incidence rate of HBV-related HCC peaked at 50-59 age group (46.5 per 100,000 persons), while the annual incidence rate of HCV-related HCC increased gradually to the ≥ 70 year age group (13.2 per 100,000 persons). Large tumors (≥ 5 cm) and portal vein invasion at initial diagnosis were more frequent in HBV-related HCC, while multiple tumors were more frequent in HCV-related HCC. In outcome analysis, HBV-related HCC showed poorer survival than HCV-related HCC [median survival: 1.34 vs. 2.17 years, adjusted hazard ratio (95% confidence interval): 0.88 (0.78-0.98), P = 0.03, adjusted for age, gender, Child-Pugh class, AJCC/mUICC stage, and initial treatment modality]. However, when divided according to the AJCC/mUICC stage, survival difference was observed only for those with AJCC/mUICC stage IV tumor, but not for AJCC/mUICC stage I, II or III tumors. The treatment outcome of each modality (resection, ablation, and transartherial chemoeombolization) was comparable between the two etiologies.

Conclusion: HBV-related and HCV-related HCC have clear differences in clinical manifestation, requiring different screening strategy according to etiology to optimize HCC surveillance in HBV-endemic area. However, etiology did not affect treatment outcomes and long-term survival within the same stage except for far advanced tumors.

Figure 1. The age-specific incidence rates of hepatocellular carcinoma (HCC) by the etiology (A), by gender in HBV-related HCC (B) and by gender in HCV-related HCC (C).

The annual incidence rates of HBV-related HCC peaked in the 50–59 age group, while the annual incidence rates of HCV-related HCC kept gradually increasing until age ≥70 s. Similar trend was observed after stratified by gender, although the peak mean annual incidence rates was observed in the 50–59 in men and in the 60–69 in women in HBV-related HCC (B). Diamonds (♦) and triangles (▴) represent for HBV and HCV-related HCC in (A), men and women in (B) and (C), respectively.

Figure 2. Long-term survival by etiology.

The median survival was significantly longer in HCV-related HCC patients than in HBV-related HCC patients. (2.17 vs. 1.34 years, P<0.01).