Postoperative Outcomes for Patients with Non-B Non-C Hepatocellular Carcinoma: A Subgroup Analysis of Patients with a History of Hepatitis B Infection

• Published in: Annals of surgical oncology 2015-12, Vol.22 (Suppl 3), p.1034-1040
• Main Authors: Omichi, Kiyohiko, Shindoh, Junichi, Yamamoto, Satoshi, Matsuyama, Yutaka, Akamatsu, Nobuhisa, Arita, Junichi, Kaneko, Junichi, Sakamoto, Yoshihiro, Hasegawa, Kiyoshi, Kokudo, Norihiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - analysis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - virology; Female; Follow-Up Studies; Hepatitis B - mortality; Hepatitis B - pathology; Hepatitis B - surgery; Hepatitis B - virology; Hepatitis B Surface Antigens - metabolism; Hepatitis B virus; Hepatitis B virus - isolation & purification; Hepatitis C virus; Hepatobiliary Tumors; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Neoplasms - virology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Postoperative Complications; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4845-0

Background Hepatocellular carcinoma (HCC) not associated with active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, termed non-B non-C HCC (nBnC-HCC), is reportedly correlated with better survival outcomes than HBV- or HCV-related HCC. However, the nBnC-HCC population includes patients with a history of HBV infection possessing anti-hepatitis B core antibodies (HBcAb), and the oncologic significance of this finding remains unclear. Methods A retrospective review of the data for 562 patients who underwent curative resection for primary HCC was performed. The clinical outcomes were compared among the following four groups: HBV group (HBsAg-positive), HCV group (HCVAb-positive), HBcAb-positive nBnC-HCC group, and pure nBnC-HCC group (negative for these viral markers). Results The HBcAb-positive nBnC-HCC group showed better overall survival (OS) and recurrence-free survival (RFS) rates than the HBV, HCV, and pure nBnC-HCC groups (5-year OS 89.4 vs 68.4, 62.0, and 66.2 %; P  = 0.003; 5-year RFS 53.8 vs 31.4, 28.1, and 33.6 %; P  = 0.01). A multivariate analysis confirmed that a history of HBV is associated with a lower risk of OS (hazard ratio [HR] 0.23; 95 % confidence interval [CI] 0.09–0.56; P  = 0.001) and RFS (HR 0.45; 95 % CI 0.27–0.73; P  = 0.001). The HBcAb-positive nBnC-HCC group was associated with a higher incidence of well-differentiated HCC (33 vs 15 %; P  = 0.03) and lower plasma des-gamma-carboxyprothrombin concentration (72 vs 357 mAu/mL; P  = 0.047) than the pure nBnC group. Conclusion The subgroup of patients with a history of HBV infection may have better survival outcomes after resection of HCC than the HBV/HCV-related or pure nBnC-HCC patients.