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A Western Dual-Center Experience

Matteo Cescon, MD; Alessandro Cucchetti, MD; Gian Luca Grazi, MD; Alessandro Ferrero, MD; Luca Viganò, MD; Giorgio Ercolani, MD; Matteo Ravaioli, MD; Matteo Zanello, MD; Pietro Andreone, MD; Lorenzo Capussotti, MD; Antonio Daniele Pinna, MD

Arch Surg. 2009;144(10):906-913.

Hypothesis  The role of hepatitis B virus (HBV) infection in determining the prognosis after hepatectomy for hepatocellular carcinoma (HCC) in patients with cirrhosis is controversial.

Design  Retrospective study based on multicenter prospectively updated databases.

Setting  Two tertiary referral centers specializing in hepatobiliary surgery.

Patients  Two hundred four consecutive patients with cirrhosis undergoing hepatectomy for single nodules of HCC of 5 cm or smaller from January 1, 1997, through September 30, 2006.

Interventions  Patients were divided into the following groups according to their preoperative viral status: HBV positive and hepatitis C virus (HCV) negative (group 1); HBV negative and HCV positive (group 2); HBV negative and HCV negative (group 3); and HBV positive and HCV positive (group 4).

Main Outcome Measures  A multivariate analysis was performed to determine factors associated with recurrence-free survival (RFS) among demographic, clinical, pathological, and surgical variables.

Results  The 2 centers had comparable RFS and early and late recurrence rates. Five-year RFS was significantly higher in groups 2 and 3 compared with group 1 (38%, 34%, and 9%, respectively; P = .007 and P = .05). Factors independently associated with RFS were HBV infection (P = .009; odds ratio, 1.79; 95% confidence interval, 1.15-2.78) and poor tumor differentiation (P < .001; odds ratio, 2.01; 95% confidence interval, 1.36-2.96). The concomitance of 0, 1, or 2 risk factors led to 5-year RFS rates of 49%, 20%, and 8%, respectively (P < .001).

Conclusions  Infection with HBV is a strong predictive factor for lower RFS after hepatectomy for a single nodule of HCC of 5 cm or smaller in patients with cirrhosis, providing a further basis for adjuvant antiviral treatment. Patients who are seropositive for HBV with poorly differentiated HCC should also be considered to be at a high risk of recurrence and possibly included in a policy of salvage liver transplantation.

Author Affiliations: Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation (Drs Cescon, Cucchetti, Grazi, Ercolani, Ravaioli, Zanello, and Pinna), and Department of Digestive Diseases and Internal Medicine (Dr Andreone), University of Bologna, Bologna, Italy; and Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy (Drs Ferrero, Viganò, and Capussotti).

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HBV and HCC: Comment on "Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinomain Patients With Cirrhosis:A Western Dual-Center Experience"
David Levi and Andreas Tzakis
Arch Surg. 2009;144(10):913.
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