Cirrhosis is present in most patients with hepatitis B and hepatocellular carcinoma

Abstract

Background & aims: There are few data available about the prevalence or effects of cirrhosis in patients with hepatocellular carcinoma (HCC) from viral hepatitis. We compared patients with HCC and hepatitis B virus (HBV) or hepatitis C virus (HCV) infections to determine the proportions of cirrhosis in each group, virologic and tumor characteristics, and overall survival.

Methods: This analysis included patients with HBV (n = 64) or HCV (n = 118) infection who were diagnosed with HCC at the Mayo Clinic in Rochester, Minnesota from 1994-2008; groups were matched for age and sex. The diagnosis of cirrhosis was based on histology and, if histologic information was insufficient or unavailable, clinical indicators that included ascites or varices, thrombocytopenia or splenomegaly, and radiographic configuration of cirrhosis. Virologic characteristics, tumor stage, and patient survival were also assessed.

Results: The prevalence of histologic cirrhosis was 88% among patients with HBV infection and 93% among those with HCV infection (P = .46). When the most inclusive criteria for cirrhosis were applied, cirrhosis was present in 94% of patients with HBV and 97% with HCV (P = .24). Among HCV patients, 5.2% were negative for HCV RNA after antiviral treatment; 63.4% of HBV patients had HBV DNA <2000 IU/mL with or without treatment. Patients with HBV tended to have less surveillance and more advanced stages of HCC, without differences in survival from those with HCV infection (P = .75).

Conclusions: Most patients with HCC and chronic viral hepatitis had evidence of cirrhosis, including those with HBV infection and those without active viral replication.

Figure 1

Comparison of advanced fibrosis/cirrhosis between HBV and HCV at HCC diagnosis Clinical indicators of cirrhosis include (1) ascites or varices, (2) platelets <150K or splenomegaly, and (3) cirrhotic configuration of the liver by cross-sectional imaging. ^aPresence of cirrhosis on histology or all three clinical cirrhosis indicators. ^bPresence of cirrhosis on histology or at least 2 clinical cirrhosis indicators. ^cPresence of cirrhosis on histology or at least 1 clinical cirrhosis indicator.

Figure 2

Comparison of survival between HBV and HCV patients