Clinical Studies Comparison of recurrence after hepatic resection in patients with hepatitis B vs. hepatitis C-related small hepatocellular carcinoma in hepatitis B virus endemic area Yi-Hsiang Huang 1,2 , Jaw-Ching Wu 1,3 , Chien-Hung Chen 4 , Ting-Tsung Chang 5 , Pui-Ching Lee 2 , Gar-Yang Chau 6 , Wing-Yiu Lui 6 , Full-Young Chang 2 and Shou-Dong Lee 2 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, 2 Division of Gastroenterology, Department of Medicine, 3 Department of Research and Education, 4 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 5 Division of Gastroenterology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, 6 Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan Huang Y-H, Wu J-C, Chen C-H, Chang T-T, Lee P-C, Chau G-Y, Lui W-Y, Chang F-Y, Lee S-D. Comparison of recurrence after hepatic resection in patients with hepatitis B vs. hepatitis C-related small hepatocellular carcinoma in hepatitis B virus endemic area. Liver International 2005: 25: 236–241. r Blackwell Munksgaard 2005 Abstract: Purpose: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are two important factors in the development of hepatocellular carcinoma (HCC). The carcinogenic mechanism of HBV and HCV is considered to be different. It is interesting to compare the recurrence after hepatic resection in patients with small HCC who were infected with HBV or HCV. Methods: From 1991 to 1995, 145 patients who were positive for hepatitis B surface antigen (HBsAg) or antibody to HCV (anti-HCV) and diagnosed as small HCC (  3 cm) in three medical centers in Taiwan were evaluated in this study. All patients underwent hepatic resection. Among them, 83 (57.2%) were infected by HBV, 51 (35.2%) were infected by HCV, and 11 (7.6%) had dual HBV and HCV infection. Results: Anti-HCV1 HCCs were associated with older age, lower serum albumin, higher alanine transaminase (ALT) level and multi-nodular tumors during diagnosis. During the follow-up, 92 (63.4%) patients developed tumor recurrence. Anti- HCV1 HCC had a higher cumulated recurrence rate than HBsAg1 HCC (72.4% vs 53.6 % at 5 year, P 5 0.032). In multivariate analysis, the presence of vascular invasion and lower serum albumin levels (o3.9 g/dl) were the determinants for tumor recurrence. Conclusions: HCV infection, as compared with HBV infection, had a higher cumulated recurrence after hepatic resection in patients with small HCC. Low serum albumin level was significantly associated with recurrence among these patients. Key words: carcinogenesis – HBV – HCV – recurrence – surgery Dr. Jaw-Ching Wu, Department of Research and Education, Taipei Veterans General Hospital, 201 Shih-Pai Road, Sec. 2, Taipei 112, Taiwan. Tel: 886-2-28712121 ext. 3218 Fax: 886-2-28745074 e-mail: jcwu@vghtpe.gov.tw Received 28 April 2004, accepted 25 August 2004                                                                                                     Hepatocellular carcinoma (HCC) is prevalent in the world (1). The long-term survival of patients with HCC after hepatic resection is not satisfac- tory because of high recurrence rate (2). Hepatitis B virus (HBV) and hepatitis C virus (HCV) are two important factors in the development of HCC (3–5). Integration of HBV DNA into host genome is the putative cause for HBV-related HCC (6–8). In contrast, HCV is an RNA virus and does not integrate into host genome. Evi- dence suggests that persistent inflammation is related to HCV carcinogenesis (9–12). This dif- ference in the pathogenesis of HBV- and HCV- related HCC may have different outcomes after curative hepatic resection. Tumor size is a factor related to tumor recur- rence after hepatic resection (2). Generally, sur- gical resection for small HCCs can provide better prognosis than that for large ones. When tumor size is small ( 3 cm), curative hepatic resection is likely to achieve. Tumor recurrence rate, or second de novo carcinogenesis rate, after curative hepatic resection of small HCC is likely to depend on initial hepatocellular carcinogenesis rate of underlying liver disease. Differences in carcino- genesis rate of underlying viral etiology may Liver International 2005: 25: 236–241 Printed in Denmark. All rights reserved Copyright r Blackwell Munksgaard 2005 DOI: 10.1111/j.1478-3231.2005.01081.x 236