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Hepatology Xagena

Clinical variations among patients with hepatocellular carcinoma based on viral cause of the disease


Significant clinical variations exist among patients with hepatocellular carcinoma ( HCC ), the most common type of liver cancer, depending on the viral cause of the disease, hepatitis B virus ( HBV ) or hepatitis C virus ( HCV ). These differences suggest that hepatitis status should be considered when developing treatment plans for newly diagnosed patients.

These findings were presented at the 2015 Annual Meeting of the American Society of Clinical Oncology ( ASCO ).
The research builds on previous studies of differential effects of demographics, geographical distribution and risk factors, including hepatitis status, on treatment outcomes among patients with inoperable hepatocellular carcinoma.
In these earlier studies, researchers observed different outcomes based on demographics and geographic patients distribution ( Asia versus Europe and USA ) among patients receiving the same local or systemic therapy approaches. They hypothesized that these differences might be attributed to variations with regard to hepatitis type, among other factors.

Currently, a patient's form of hepatitis is not a factor in treatment planning, but the two types of the virus result in different disease impacts and some variations in outcomes. Most likely, this is related to the difference in how hepatitis leads to cancer development, in addition to the differences in the natural history of both hepatitis forms.

In the current study, researchers investigated detailed characteristics of 815 patients with hepatocellular carcinoma treated at MD Anderson between 1992 and 2011, assessing a range of disease-state variables and survival rates.
HBV is a DNA virus and HCV is an RNA virus, and it has previously been unclear whether this difference might influence the clinical-pathologic features of hepatocellular carcinoma or patient outcomes.

Researchers found that patients with HBV were more likely to develop hepatocellular carcinoma at a younger age than HCV patients and presented more aggressive disease, marked by: advanced diagnosis stage ( 3-6 ); high alpha-fetoprotein, a cancer signal and measure of how well treatments are working; poorly differentiated tumor cells, which tend to grow and spread more quickly; larger tumor size; extent of cancer in the liver ( more than 50% of the liver volume ), a factor for metastases; and portal thrombosis, a blockage or narrowing of the vessel that brings blood to the liver from the intestines.

Patients with HCV-associated cancer were more likely to exhibit: underlying cirrhosis; have a history of greater alcohol and cigarette use; and a higher rate of diabetes.

The median survival rates were 10.9 and 9.3 months for HCV and HBV, respectively. ( Xagena )

Source: The University of Texas MD Anderson Cancer Center, 2015

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