Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 58-68
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.58
Correlation between smoking habit and surgical outcomes on viral-associated hepatocellular carcinomas
Keita Kai, Sho Komukai, Hiroki Koga, Koutaro Yamaji, Takao Ide, Atsushi Kawaguchi, Shinichi Aishima, Hirokazu Noshiro
Keita Kai, Shinichi Aishima, Department of Pathology, Saga University Hospital, Saga 849-8501, Japan
Sho Komukai, Clinical Research Center, Saga University Hospital, Saga 849-8501, Japan
Hiroki Koga, Koutaro Yamaji, Takao Ide, Hirokazu Noshiro, Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
Koutaro Yamaji, Shinichi Aishima, Department of Pathology and Microbiology, Saga University Faculty of Medicine, Saga 849-8501, Japan
Atsushi Kawaguchi, Center for Comprehensive Community Medicine, Saga University Faculty of Medicine, Saga 849-8501, Japan
Author contributions: Kai K, the main author of this article, designed the study, conducted the data collection, and contributed to the statistical analyses; Komukai S and Kawaguchi A performed the statistical analyses; Koga H, Yamaji K, and Ide T contributed to the data collection; Aishima S and Noshiro H contributed to the data collection and reviewed the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The protocol of this study was reviewed and approved by the Ethics Committee of the Faculty of Medicine at Saga University.
Informed consent statement: Informed consent for the use of resected tissue and medical information was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are 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: Keita Kai, MD, PhD, Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga City, Saga 849-8501, Japan. kaikeit@cc.saga-u.ac.jp
Telephone: +81-952-343264 Fax: +81-952-342055
Received: October 26, 2017
Peer-review started: October 27, 2017
First decision: November 21, 2017
Revised: December 2, 2017
Accepted: December 12, 2017
Article in press: December 12, 2017
Published online: January 7, 2018
Abstract
AIM

To investigate the association between smoking habits and surgical outcomes in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) (B-HCC) and hepatitis C virus (HCV)-related HCC (C-HCC) and clarify the clinicopathological features associated with smoking status in B-HCC and C-HCC patients.

METHODS

We retrospectively examined the cases of the 341 consecutive patients with viral-associated HCC (C-HCC, n = 273; B-HCC, n = 68) who underwent curative surgery for their primary lesion. We categorized smoking status at the time of surgery into never, ex- and current smoker. We analyzed the B-HCC and C-HCC groups’ clinicopathological features and surgical outcomes, i.e., disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS). Univariate and multivariate analyses were performed using a Cox proportional hazards regression model. We also performed subset analyses in both patient groups comparing the current smokers to the other patients.

RESULTS

The multivariate analysis in the C-HCC group revealed that current-smoker status was significantly correlated with both OS (P = 0.0039) and DSS (P = 0.0416). In the B-HCC patients, no significant correlation was observed between current-smoker status and DFS, OS, or DSS in the univariate or multivariate analyses. The subset analyses comparing the current smokers to the other patients in both the C-HCC and B-HCC groups revealed that the current smokers developed HCC at significantly younger ages than the other patients irrespective of viral infection status.

CONCLUSION

A smoking habit is significantly correlated with the overall and disease-specific survivals of patients with C-HCC. In contrast, the B-HCC patients showed a weak association between smoking status and surgical outcomes.

Keywords: Hepatocellular carcinoma, Hepatitis B virus, Hepatitis C virus, Smoking, Surgery, Prognosis

Core tip: We retrospectively analyzed the association between smoking habits and surgical outcomes in 68 cases of hepatitis B virus-related hepatocellular carcinoma (HCC) (B-HCC) and 273 cases of hepatitis C virus (HCV)-related HCC (C-HCC). Smoking habit was revealed as significantly correlated with the overall survival and disease-specific survival of the C-HCC patients, whereas the B-HCC patient group showed a weak association between smoking habit and surgical outcomes. Our subset analyses comparing the current smokers to the other patients revealed that the current smokers developed HCC at significantly younger ages compared to the other patients irrespective of viral infection status.