Effects of Cirrhosis on Short-term and Long-term Survival of Patients With Hepatitis B–related Hepatocellular Carcinoma

Vincent L. Chen, An K. Le, Nathan G. Kim, Lily H. Kim, Nghia H. Nguyen, Pauline P. Nguyen, Changqing Zhao, Mindie H. Nguyen

Hepatitis B virus (HBV) is the most common cause of hepatocellular carcinoma (HCC) worldwide. Unlike other liver diseases, HBV can cause HCC in the absence of cirrhosis. We investigated whether features of HCC in patients with HBV infection without cirrhosis, and survival times, differ from those of patients who develop HCC after cirrhosis. We performed a retrospective cohort study of 487 consecutive cases of HBV-related HCC seen, from 2000 through 2014, at a tertiary care center. Laboratory values, imaging results, and treatment information were obtained from subjects' medical records. Symptoms of HCC included weight loss, abdominal pain, or new hepatic decompensation. The primary outcome was overall survival, categorized as short-term survival (up to 3 years after the diagnosis of HCC) or long-term survival (3-10 years after diagnosis). The mean tumor size at diagnosis was significantly larger in patients without cirrhosis (6.4±4.3 cm) than patients with cirrhosis (5.0±3.8 cm) (P=.0009). A significantly larger proportion of patients without cirrhosis had symptoms at diagnosis (43.8% vs 35.4% in patients without cirrhosis; P=.09). A significantly higher proportion of patients without cirrhosis survived for the long term (P=.003), but there was no significant difference between groups in short-term survival (P=.37). Notably, the same proportions of asymptomatic patients with and without cirrhosis survived for the short term (64.3% vs 64.2%; P=.73), but a lower proportion of asymptomatic patients with cirrhosis survived for the long term (P=.015). In multivariate Cox regression analysis, cirrhosis was an independent predictor of death in 3-10 years (HR = 3.76, P=.003) but not in less than 3 years (P=.48). Symptoms at diagnosis predicted death within 3 years (HR = 1.76; P=.006) but not in 3-10 years (P=.15). Patients with HBV infection and HCC without cirrhosis present with larger tumors, and a larger percentage have symptoms of the cancer, than patients with cirrhosis. This indicates that HCC surveillance is less than optimal for patients with HBV infection without cirrhosis. These patients have similar short-term survival compared to patients with cirrhosis, so efforts are needed to increase adherence and effectiveness of HCC surveillance for this group.