Hepatitis B Confers Worse Outcomes, More Advanced Disease

Marc Uemura, MD, MBA

Patients with hepatocellular carcinoma (HCC) that was related to hepatitis B virus (HBV) infection were found to have more advanced clinicopathologic features and worse outcomes compared with those with hepatitis C virus (HCV)-related HCC, according to a retrospective analysis conducted on historical data from patients treated at the MD Anderson Cancer Center.

"Hepatitis B HCC patients tended to have shorter overall survival and time to progression regardless of systemic therapy, although the difference was not statistically significant," Marc Uemura, MD, MBA, fellow, hematology and medical oncology, MD Anderson Cancer Center, said during a presentation of the results at the 2015 ASCO Annual Meeting.

In the study, single institution medical records for 815 patients with viral-related HCC from 1992 to 2011 were reviewed. HCV was present in 472 patients (58%), while HBV was seen in 343 individuals (42%). Viral status was confirmed by serology.

A number of clinical and pathologic differences were seen between the two groups of patients. Those in the HBV versus HCV arm, respectively, were younger (57.4 vs 61.3 years;P<.001), had poorly differentiated tumors (26.5% vs 18.8%;P= .001), a higher incidence of portal thrombosis (35.7% vs 30.2%;P= .05), larger tumors (>5cm; 49.4% vs 35.2%;P= .02), higher tumor volume (>50%; 42.9% vs 26.6%;P< .001), and lower levels of underlying cirrhosis (59.5% vs 86%;P<.001).

Other lifestyle factors varied between the two arms. Compared with the HBV group, those with HCV-related HCC had a higher coincidence of smoking (73% vs 56.4%;P<.001), alcohol consumption (70.1% vs 49.3%;P<.001), and type 2 diabetes (23.5% vs 18.3%;P= .05).

In terms of therapy and biomarker differences, more patients in the HBV arm had received systemic therapy (36.9% vs 27.5%;P<.001); however, more patients with HCV were treated locally (27.5% vs 17.6%;P<.001). AFP levels in the HBV arm were 55,708 IU/mL (&plusmn;10,950) compared with 17,894 IU/mL (&plusmn;4,662) in the HCV arm (P<.001).

A trend toward better overall survival (OS) was seen in the HCV arm versus HBV; however, this was not statistically significant (P= .9). In the HCV arm, the median OS was 10.9 versus 9.3 months in the HBV arm. Similarities in OS held up across treatment modalities, with a trend favoring improved survival seen in HBV patients treated with ablation (27.3 vs 32.5 months;P= .1).

"Across all of these categorical groups, the hepatitis B patients tended to do a little worse than the hepatitis C patients in terms of overall survival," Uemura observed.

For time to progression (TTP), sorafenib was the only treatment that led to a significant difference between the two groups. In the HCV arm sorafenib showed a 7.6-month TTP compared with 3.8 months in the HBV arm (P= .04).

"Our results suggest the need for HCC stratification based on hepatitis status in clinical. However, multi-institutional prospective validation studies are warranted," Uemura concluded.

Uemura MI, Kaseb AO, Abdel-Wahab R, et al. Hepatitis B- and C-associated hepatocellular carcinoma in a large US cancer center: Do clinicopathologic features or patient outcomes differ by the potentially causative viruses? J Clin Oncol. 2015;33 (suppl; abstr 4011).