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Parenchymal Fibrosis and Cancer Specific Outcomes Following Liver Resection in Patients with HBV Associated Hepatocellular Carcinoma
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Reported by Jules Levin
AASLD Nov 2009, Boston, MA
Hiotis SP1, Manizate F1, Fiel MI2, Labow DM1, Roayaie S1, and Schwartz ME1
Depts. of Surgery1 and Pathology2, Mount Sinai School of Medicine, New York, NY
Introduction: Unlike most risk factors for HCC, chronic HBV is often associated with cancers occurring in the absence of cirrhosis. This observation suggests a dual pathway to hepatocarcinogenesis in patients with HBV: one preceded by severe chronic inflammatory events and cirrhosis, and an alternate cirrhosis-independent pathway. The purpose of this investigation is to determine whether differences in oncologic behavior are exhibited by cirrhosis-associated vs. cirrhosis-independent HBV-HCC.
Methods: Patients with HCC treated at Mount Sinai Hospital (New York, NY) between the years of 1988 and 2008 were entered into a prospective clinical research database. An analysis was performed on those patients with HBV-HCC treated with liver resection, and an objective assessment of parenchymal fibrosis (Histologic Acitivity Index, HAI) was recorded. Cancer-specific outcomes including survival and cancer recurrence were determined via Kaplan-Meier analysis and compared via log rank test.
Results: Among 2830 total patients treated for HCC during the study period, 684 assessable cases were attributed to chronic HBV and 241 (35%) of HBV-HCC cases were treated with liver resection. Cirrhosis (stage 4 fibrosis) was established at the time of initial cancer diagnosis in 134/241 (56%) HBV-HCC patients, with normal parenchyma (36/241, 15%) or less severe fibrosis (stage 1-3 fibrosis: 71/241, 29%) in the remaining HBV-HCC patients. Oncologic outcomes were least favorable in patients with cirrhosis, while patients with normal or fibrotic liver parenchyma had more favorable overall survival and cancer recurrence rates. (Table 1)
Conclusions: Patients with HBV-HCC treated with liver resection demonstrate better cancer-specific outcomes when diagnosed with cancer in the absence of cirrhosis. These data suggest that cancers occurring in the absence of cirrhosis or severe chronic inflammatory events demonstrate more favorable biologic behavior. Prevention of progression to cirrhosis may improve chronic HBV-associated outcomes, both in terms of liver function and cancer prognosis.
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