Impact of Viral Etiology on Postoperative De Novo Recurrence After Hepatectomy for Hepatocellular Carcinoma in Cirrhotic Patients

Kazunari Sasaki, Junichi Shindoh, Yujiro Nishioka, Georgios A. Margonis, Toshitaka Sugawara, Nikolaos Andreatos, Masaji Hashimoto, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background and Aim: Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) are associated with viral hepatitis, especially hepatitis B virus (HBV) and hepatitis C virus (HCV). Whether differences exist in postoperative de novo carcinogenesis from established cirrhosis according to viral etiology remains unclear. Methods: Data from 313 LC patients with viral hepatitis (HBV-LC, n = 108 and HCV-LC, n = 205) who underwent curative-intent hepatectomy for HCC were retrospectively collected. Clinicopathological characteristics, cumulative recurrence, chronological change of recurrence rate, and predictors of recurrence were analyzed. Results: Baseline patient characteristics were different among patients with HBV versus HCV as HCC-LC patients had a lower albumin, higher alanine transaminase, and higher incidence of tumor multicentricity (all P < 0.050). The 1-, 3-, and 5-year cumulative recurrence was 16.7, 38.6, and 53.7% in HBV-LC versus 20.8, 52.2, and 71.6% in HCV-LC (P = 0.002) patients, respectively. The postoperative annual recurrence rates of HCV-LC were consistently higher than that of HBV-LC patients. After matching on clinicopathologic characteristics, while recurrence was comparable in the early time period, HCV-LC patients had a 2–5% higher incidence of recurrence compared with HBV-LC patients after 20 months post-resection. On multivariable analysis, HCV infection was an independent predictor of recurrence (HR 1.55; 95% CI 1.13–2.13). Conclusion: HCV-related LC was associated with a higher postoperative de novo carcinogenesis than HBV-related LC. Establishment of different treatment algorithms as well as follow-up surveillance protocols stratified by viral etiology may be warranted.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Gastrointestinal Surgery
StateAccepted/In press - Jan 3 2017


  • Hepatectomy
  • Hepatitis B virus
  • Hepatitis C virus
  • Hepatocellular carcinoma
  • Liver cirrhosis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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