COMPARISON OF CLINICOPATHOLOGICAL FEATURES IN HEPATITIS-B VIRUS-ASSOCIATED HEPATOCELLULAR-CARCINOMA WITH OR WITHOUT HEPATITIS-D VIRUS SUPERINFECTION

Background/Aims: Hepatitis D virus superinfection in hepatitis B virus carriers produces additional damage in an already injured liver. Earl ier reports noted that the development of hepatocellular carcinoma may be accelerated in hepatitis D virus-superinfected patients. This stud y aimed to investigate the impact of hepatitis D virus on the clinical course of hepatitis B virus-associated hepatocellular carcinoma. Meth ods: A total of 42 consecutive hepatocellular carcinoma cases seroposi tive for antibody against hepatitis D virus antigen (anti-HDV) were fo und from 1986 to 1994; the clinical manifestations, treatment and outc omes were compared with 255 consecutive hepatocellular carcinoma cases seropositive for hepatitis B virus surface antigen but seronegative f or anti-HDV. Results: The mean age was 60 years in both groups of pati ents. Other features, including sex, duration of follow-up, presence o f cirrhosis or ascites, serum biochemistry, status of HBV-e antigen, a nd gross and microscopic tumor appearance, were not significantly diff erent between the two groups. Though more patients in the anti-HDV-pos itive group underwent active treatment (operation or transcatheter art erial chemoembolization) than those in the anti-HDV-negative group (54 .8% in 42 versus 34.9% in 255 cases, p= 0.02), the cumulative 4-year s urvival rates (9.5% versus 9.8%) were similar. For the anti-HDV-positi ve hepatocellular carcinoma patients, tumor size <5 cm and active trea tment were favorable prognostic predictors associated with survival >1 8 months. Conclusion: Hepatitis D virus superinfection does not accele rate the development of hepatocellular carcinoma. The clinical manifes tations were similar, and the outcome in anti-HDV-positive patients wa s not worse than in the general HBV-associated hepatocellular carcinom a patients, as long as they were diagnosed at an early stage and activ ely treated.