Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
PLoS One. 2024 Mar 15;19(3):e0290523. doi: 10.1371/journal.pone.0290523. eCollection 2024.
Whether the etiology of chronic liver disease (CLD) impacts the overall survival (OS) of patients with hepatocellular carcinoma (HCC) remains unclear. We aim to clarify this issue.
Between 2011 and 2020, 3941 patients who were newly diagnosed with HCC at our institution were enrolled in this study. In patients with multiple CLD etiologies, etiology was classified using the following hierarchy: hepatitis C virus (HCV) > hepatitis B virus (HBV) > alcohol-related > all negative. All negative was defined as negative for HCV, HBV, and alcohol use disorder.
Among 3941 patients, 1407 patients were classified with HCV-related HCC, 1677 patients had HBV-related HCC, 145 patients had alcohol-related HCC, and 712 patients had all-negative HCC. Using the all-negative group as the reference group, multivariate analysis showed that HBV is an independent predictor of mortality (hazard ratio: 0.856; 95% confidence interval: 0.745-0.983; p = 0.027). Patients with HBV-related HCC had superior OS compared with patients with other CLD etiologies (p<0.001). Subgroup analyses were performed, for Barcelona Clinic Liver Cancer (BCLC) stages 0-A (p<0.001); serum alpha-fetoprotein (AFP) levels≧20 ng/ml (p<0.001); AFP levels < 20 ng/ml (p<0.001); age > 65 years (p<0.001); and the use of curative treatments (p = 0.002). No significant difference in OS between HBV and other etiologies was observed among patients aged ≤ 65 years (p = 0.304); with BCLC stages B-D (p = 0.973); or who underwent non-curative treatments (p = 0.1).
Patients with HBV-related HCC had superior OS than patients with other HCC etiologies.
慢性肝病（CLD）的病因是否会影响肝细胞癌（HCC）患者的总生存期（OS）尚不清楚。我们旨在阐明这个问题。
在 2011 年至 2020 年间，我院共纳入 3941 例新诊断为 HCC 的患者。在具有多种 CLD 病因的患者中，病因采用以下层次结构进行分类：丙型肝炎病毒（HCV）>乙型肝炎病毒（HBV）>酒精相关>全部阴性。全部阴性定义为 HCV、HBV 和酒精使用障碍均为阴性。
在 3941 例患者中，1407 例患者被归类为 HCV 相关 HCC，1677 例患者为 HBV 相关 HCC，145 例患者为酒精相关 HCC，712 例患者为全部阴性 HCC。以全部阴性组为参照组，多因素分析显示 HBV 是死亡的独立预测因素（风险比：0.856；95%置信区间：0.745-0.983；p=0.027）。与其他 CLD 病因相比，HBV 相关 HCC 患者的 OS 更优（p<0.001）。进行了亚组分析，对于巴塞罗那临床肝癌（BCLC）分期 0-A（p<0.001）；血清甲胎蛋白（AFP）水平≧20ng/ml（p<0.001）；AFP 水平<20ng/ml（p<0.001）；年龄>65 岁（p<0.001）；以及采用治愈性治疗（p=0.002）。在年龄≤65 岁的患者中，HBV 与其他病因之间的 OS 无显著差异（p=0.304）；BCLC 分期 B-D（p=0.973）；或接受非治愈性治疗（p=0.1）。
与其他 HCC 病因相比，HBV 相关 HCC 患者的 OS 更优。
