Comparison of surgical outcomes for hepatocellular carcinoma in patients with hepatitis B versus hepatitis C: A western experience

Background: We reviewed our experience in patients with hepatocellular carc inoma (HCC) and chronic hepatitis to determine if differences exist in preo perative status and postoperative survival between those with hepatitis B v irus (HBV) and hepatitis C virus (HCV) infections. Methods: We reviewed the records of 240 consecutive patients with HCC who u nderwent hepatic resection or liver transplantation at Mount Sinai Hospital between February 1990 and February 1998. Patients who tested negative for hepatitis B antigen and hepatitis C antibody (74 patients) as well as those who tested positive for both (2 patients) were excluded. Age as well as pr eoperative platelet count, prothrombin time (PT), albumin, and total biliru bin were measured in all patients. The presence of encephalopathy or ascite s also was noted. Explanted livers and resection specimens were examined fo r size, number, and differentiation of tumors as well as the presence of va scular invasion and cirrhosis in the surrounding parenchyma. Results: One hundred twenty-one patients with HCC tested positive for HCV, and 43 tested positive for HBV. A significantly higher proportion of patien ts with HCV required transplant for the treatment of their HCC when compare d to those with HBV. In the resection group, patients with HCV were signifi cantly older that those with HBV. They also had significantly lower mean pr eoperative platelet counts and albumin levels and higher mean PT and total bilirubin levels. Resected patients with HCV had significantly less-differe ntiated tumors and a higher incidence of vascular invasion and cirrhosis wh en compared to those with HBV. There was no statistical difference in the m ulticentricity and size of tumors between the two groups. The 5-year diseas e-free survival was significantly higher far HBV patients treated with rese ction when compared to those with HCV (49% vs. 7%, P = .0480). Patients wit h HCC and HCV had significantly longer 5-year disease-free survival with tr ansplant when compared to resection (48% vs. 7%, P = .0001). Transplanted p atients with HBV and HCC had preoperative status, pathological findings, an d survival similar to those of patients with HCV. Conclusions: Based on preoperative liver function and tumor location, a muc h higher proportion of HCC patients with HBV were candidates for resection. Significant differences in preoperative status, tumor characteristics and disease-free survival exist between HCC patients with chronic HBV and HCV i nfection who have not yet reached end-stage liver disease. Serious consider ation should be given to transplanting resectable HCC with concomitant HCV, especially in cases with small tumors.