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Progression of hepatitis B and C to hepatocellular carcinoma in Western countries
1Istituto Patologia Speciale Medica, Cattedra Medicina Interna, University of Verona, Policlinico Borgo Roma, Italy.
Insights
Hepatitis B (HBV) and C (HCV) infections cause liver disease and cancer, primarily in cirrhotic livers. Risk factors include age, sex, and liver disease severity, with similar cancer risks for HBV and HCV cirrhosis.
Area of Science:
- Hepatology
- Viral Hepatitis
- Oncology
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are leading causes of chronic liver disease and hepatocellular carcinoma (HCC) globally.
- In Western nations, HCC linked to HBV or HCV predominantly arises in cirrhotic livers.
Purpose of the Study:
- To examine epidemiological evidence for HBV and HCV as causes of HCC in Caucasian patients with cirrhosis.
- To identify host and disease-related predictors of HCC in cirrhosis.
- To assess the risk of HCC in HBV- vs. HCV-related cirrhosis.
Main Methods:
- Longitudinal study of Caucasian patients with compensated cirrhosis.
- Analysis of host factors (age, sex, age at infection) and liver disease parameters (bilirubin, platelets).
- Evaluation of HCC incidence in HBV- and HCV-related cirrhosis.
Main Results:
- HCC incidence was ~2 and 2.5 per 100 person-years for HBV- and HCV-related cirrhosis, respectively.
- Age, age at infection, male sex, bilirubin, and platelet count were significant HCC predictors.
- Concurrent HBV/HCV infection and heavy alcohol intake synergistically increased HCC risk.
Conclusions:
- Epidemiological data confirm HBV and HCV as significant contributors to HCC in Western cirrhotic patients.
- HCC risk is similar for HBV- and HCV-related cirrhosis, predominantly affecting patients with long-standing disease.
- Sustained virological remission in HBV cirrhosis may reduce HCC risk.
Abstract:
Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of chronic liver disease and hepatocellular carcinoma (HCC) worldwide. In Western countries most HCC associated with HBV or HCV infection occurs in the cirrhotic liver. In a longitudinal studies of series of a Caucasian patients with compensated cirrhosis the incidence of HCC was approximately 2 and 2.5 per 100 person-years for HBV-related and HCV-related cirrhosis, respectively. The host factors of age, age at infection and male sex as well as parameters reflecting the severity of liver disease, such as bilirubin and platelets, appear to be significant predictors of liver cancer in patients with cirrhosis. It is still controversial whether HCV genotype 1b has a specific oncogenic potential. Studies from Europe have shown a low risk for HCC in patients with compensated cirrhosis type B who achieve a sustained virological and disease remission. Overall these data strengthen the epidemiological evidence of the association among HBV infection, cirrhosis and HCC in the West, indicating a similar risk for liver cancer in Caucasian patients with cirrhosis type B or C and suggest that tumors occur mainly in patients with long-standing disease. Additional factors that may promote liver cancer include concurrent HBV and HCV infection (approximately 5 fold-increase in risk) or concomitant heavy alcohol intake (synergism).
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