Sasaki Kazunari, Shindoh Junichi, Nishioka Yujiro, Margonis Georgios A, Sugawara Toshitaka, Andreatos Nikolaos, Hashimoto Masaji, Pawlik Timothy M
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street Blalock 688, Baltimore, MD, 21287, USA.
Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
J Gastrointest Surg. 2017 Mar;21(3):487-495. doi: 10.1007/s11605-016-3344-3. Epub 2017 Jan 3.
Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear.
Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed.
Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2-5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13-2.13).
HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.
肝硬化（LC）和肝细胞癌（HCC）与病毒性肝炎相关，尤其是乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）。根据病毒病因，已确诊肝硬化患者术后新发癌的情况是否存在差异尚不清楚。
回顾性收集313例因HCC接受根治性肝切除术的病毒性肝炎LC患者的数据（HBV-LC患者108例，HCV-LC患者205例）。分析临床病理特征、累积复发率、复发率的时间变化以及复发的预测因素。
HBV与HCV患者的基线特征不同，因为HCC-LC患者白蛋白水平较低、丙氨酸转氨酶较高且肿瘤多中心发生率较高（所有P<0.050）。HBV-LC患者1年、3年和5年的累积复发率分别为16.7%、38.6%和53.7%，而HCV-LC患者分别为20.8%、52.2%和71.6%（P=0.002）。HCV-LC患者的术后年复发率始终高于HBV-LC患者。在对临床病理特征进行匹配后，虽然早期复发情况相当，但HCV-LC患者在切除术后20个月后的复发率比HBV-LC患者高2%-5%。多变量分析显示，HCV感染是复发的独立预测因素（HR 1.55；95%CI 1.13-2.13）。
与HBV相关的LC相比，HCV相关的LC术后新发癌的发生率更高。可能有必要制定不同的治疗算法以及根据病毒病因分层的随访监测方案。
