Clinical Trials Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2017; 23(15): 2763-2770
Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2763
Patients with non-viral liver disease have a greater tumor burden and less curative treatment options when diagnosed with hepatocellular carcinoma
Waled Mohsen, Marcia Rodov, Emilia Prakoso, Barbara Charlton, David G Bowen, David J Koorey, Nicholas A Shackel, Geoffrey W McCaughan, Simone I Strasser
Waled Mohsen, Marcia Rodov, Emilia Prakoso, Barbara Charlton, David G Bowen, David J Koorey, Nicholas A Shackel, Geoffrey W McCaughan, Simone I Strasser, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia
Author contributions: Mohsen W analysed data, wrote the paper and completed statistics; Rodov M collected and analysed data and assisted with the manuscript; Prakoso E, Bowen DG, Koorey DJ, Shackel NA and McCaughan GW added clinic patients to the prospective database; Charlton B maintained the prospective database; Strasser SI designed the research study, supervised researchers, obtained ethics approval, set up the database, contributed to the manuscript.
Institutional review board statement: The clinical database and this study were approved by the SLHD Ethics Review Committee (Royal Prince Alfred Zone).
Informed consent statement: Informed consent was given by all participants of the study prior to inclusion.
Conflict-of-interest statement: There are no conflicts of interests recorded for this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the first author at wmoh6298@uni.sydney.edu.au. Participants gave informed consent for data sharing. No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Mohsen Waled, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital Missenden, Rd Camperdown, Sydney NSW 2050, Australia. wmoh6298@uni.sydney.edu.au
Telephone: +61-4-21967316 Fax: +61-2-95158242
Received: November 8, 2016
Peer-review started: November 8, 2016
First decision: December 19, 2016
Revised: January 8, 2017
Accepted: March 6, 2017
Article in press: March 6, 2017
Published online: April 21, 2017
Abstract
AIM

To assess the impact of underlying liver disease etiology on the presenting features and outcomes in a large cohort of patients with hepatocellular carcinoma (HCC).

METHODS

A prospective database of all patients with HCC was established from 1998 to March 2012. One thousand and seventy-eight patients were categorized into three groups, based on the etiology of their liver disease: hepatitis B virus (HBV), hepatitis C virus (HCV) and non-viral liver disease (NVLD). Overall survival was determined by Kaplan Meier analysis to time of death or last follow-up.

RESULTS

HCC patients with HCV (85%) were more likely to be diagnosed as part of a surveillance program, compared to HBV or NVLD (both 71%) (P < 0.001). Patients with NVLD were more likely to receive best supportive care (29%) compared to those with HBV (21%) or HCV (20%) (P < 0.02). Twelve percent of NVLD and 13% of HBV patients underwent liver transplantation compared to 21% of HCV patients (P = 0.001). Median survival from presentation was lowest in NVLD (1.7 years) when compared to HBV (2.8 years) and HCV (2.6 years) (P < 0.05). In multivariate analysis, independent predictors of survival included Child Turcotte Pugh score, size of dominant lesion, absence of vascular invasion, and management with surgical resection or liver transplantation. Patient age and the etiology of the underlying liver disease were not independent predictors of survival

CONCLUSION

Patients with NVLD and HCC were less likely to be enrolled in a HCC surveillance program and are less likely to have curative therapies such as liver resection and transplantation after diagnosis with HCC, when compared to patients with Hepatitis B and Hepatitis C.

Keywords: Hepatitis B, Hepatitis C, Hepatocellular carcinoma, Surveillance, Therapy, Nonalcoholic fatty liver disease, Survival

Core tip: In this prospective study of 1078 patients, we examined the relationship between etiology of liver disease with clinical presentation and outcome, following a diagnosis of hepatocellular carcinoma. Our results are clinically useful and relevant for gastroenterologists worldwide. In our diverse and multi-ethnic cohort, patients diagnosed with hepatocellular carcinoma (HCC), who have a background of non-viral liver disease are: (1) Less likely to be participating in an HCC surveillance program; (2) Have more severe liver disease at diagnosis; (3) Have a greater tumor burden at diagnosis; and (4) Less likely to have curative therapies for HCC like liver transplantation or liver resection.