Viral serostatus and coexisting inflammatory activity affect metachronous carcinogenesis after hepatectomy for hepatocellular carcinoma. A further report

Little data are available regarding the effects of hepatitis virus serostat us and the severity of coexisting chronic inflammation on intrahepatic recu rrence after hepatectomy for hepatocellular carcinoma (HCC). We investigate d the extent to which these factors modified the prognosis of hepatectomize d patients. A total of 274 patients treated in the period January 1981 to D ecember 1996 were divided into three groups: antihepatitis C-positive (HCV; n = 144), hepatitis B surface antigen-positive and HCV antibody (Ab)-negat ive (HBsAg; n = 106), and HBsAg-negative and HCV Ab-negative (NBNC; n = 20) . Positivity for HBV-related antibody in the HCV group was 76%. Histologic grading of inflammatory activity from coexisting hepatitis was determined a ccording to Knodel's histological activity index (HAI) scoring system. Post -hepatectomy crude survival rates and disease-free survival (DFS) rates wer e compared, according to tumor characteristics, between the three groups. I n the patients overall and also in the patients with a single nodular HCC, the HCV group had significantly higher HAI scores and preoperative serum as partate aminotransaminase (AST) levels than the other two groups. When the patients were limited to those with a single nodular HCC, the crude surviva l was similar in the three groups with comparable tumor characteristics; ho wever, the DFS was different (NBNC > HBsAg > HCV). When the patients were f urther limited to those with a single nodular HCC without microscopic extra capsular spread, in whom removal of the tumor was expected to be microscopi cally complete, the difference in the DFS became more marked. Irrespective of the viral serostatus, better crude and disease-free survivals were obser ved in the patients with lower AST levels (less than or equal to 50 IU/1) t han in those with higher AST levels (>50 IU/1). In contrast, there were no differences in survivals and HAI scores according to the presence or absenc e of HBV-related antibody in the HCV group. From our univariate analysis, w e can conclude that the severity of virally induced inflammation, which was well correlated with viral serostatus, may be a factor that affects intrah epatic recurrence, which is more likely to originate from metachronous carc inogenesis. Prior co-infection of HBV in HCV patients may not be an adverse risk factor for intrahepatic recurrence.