Risk of recurrence in a long-term follow-up after surgery in 417 patients with hepatitis B- or hepatitis C-related hepatocellular carcinoma

Ann Surg. 2006 Nov;244(5):771-80. doi: 10.1097/01.sla.0000225126.56483.b3.


Objective: The aim of this study is to clarify the difference of risk of recurrence after hepatic resection between patients with hepatitis B- and hepatitis C-related hepatocellular carcinoma (HCC).

Summary and background data: HCC is a highly recurrent carcinoma. However, consensus has not yet been reached about the relationship between hepatitis virus types and risk of recurrence in a long-term follow-up for HCC patients who underwent hepatic resection.

Patients and methods: From the beginning of January 1990 to the end of December 1999, of 469 HCC patients who underwent curative hepatic resection, 66 (14%) patients with positive hepatitis B virus surface antigen (HBs-Ag) and negative hepatitis C virus antibody (HCV-Ab) were regarded to have B-type hepatitis (HB)-related HCC (HB-HCC) and 351 (75%) with negative HBs-Ag and positive HCV-Ab were regarded to have C-type hepatitis (HC)-related HCC (HC-HCC). A clinical follow-up was performed to assess the existence of recurrence with the median follow-up periods of 11.0 and 10.1 years for HB- and HC-HCC patients, respectively.

Results: The 3-, 5-, and 10-year disease-free survival (DFS) rates of HC-HCC (40%, 24%, and 12%, respectively) were significantly shorter than those of HB-HCC (57%, 54%, and 28%, respectively) (P = 0.0001). In multivariate Cox proportional hazard analysis, viral type, TNM stage, surgical margin, and Edmondson's grade were significantly associated with risk of recurrence. The risk of recurrence from the initial HCC increased to 1.93 times (95% confidence interval, 1.27-2.93) greater in HC-HCC patients than in HB-HCC patients.

Conclusion: Hepatitis viral type is an independent factor for recurrence of HCC in a long-term clinical follow-up. This finding suggests that we may need a different strategy to control postoperative recurrence by the viral types in HCC patients.

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / surgery*
  • Female
  • Follow-Up Studies
  • Hepatectomy*
  • Hepatitis B / complications*
  • Hepatitis C / complications*
  • Humans
  • Incidence
  • Liver Neoplasms / complications
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / surgery*
  • Male
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / etiology*
  • Neoplasm Staging
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Treatment Outcome