Hepatocellular carcinoma in hepatitis D: does it differ from hepatitis B monoinfection?

Area of Science:

• Hepatology
• Oncology
• Virology

Background:

• Hepatitis D virus (HDV) superinfection accelerates liver injury and cirrhosis in chronic hepatitis B (HBV) patients.
• Hepatocellular carcinoma (HCC) development may differ between HDV superinfection and HBV monoinfection.

Purpose of the Study:

• To compare the clinical characteristics of HCC in patients with HDV superinfection versus HBV monoinfection.

Main Methods:

• A comparative study involving 92 HCC patients with HDV (HDV group) and 92 HCC patients with HBV monoinfection (HBV group).
• Analysis included clinical features, biochemical data, tumor characteristics, and staging systems (Child-Pugh, Barcelona Clinic Liver Cancer, Okuda, TNM).

Main Results:

• No significant differences were observed in sex, BMI, ascites, serum biochemistry, tumor appearance, or Child-Pugh/Okuda stages.
• HDV patients exhibited smaller liver size (P=0.000), lower platelet counts (P=0.053), and larger esophageal varices (P=0.004).
• HBV patients more frequently presented with multifocal tumors (P=0.040), elevated alpha-fetoprotein >1000 IU/mL (P=0.061), and advanced TNM stage III-IV disease (P=0.000).

Conclusions:

• HDV superinfection in HCC patients is associated with decreased liver size and more severe portal hypertension.
• These findings suggest HDV influences HCC development differently than HBV monoinfection, potentially through enhanced inflammation and cirrhosis.
• Earlier TNM staging in HDV-infected patients indicates a distinct oncogenic pathway possibly driven by indirect mechanisms.