Risk Factors for Recurring Hepatocellular Carcinoma Differ According to Infected Hepatitis Virus—An Analysis of 236 Consecutive Patients With A Single Lesion

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Abstract
Patients with hepatocellular carcinoma (HCC) frequently experience intrahepatic HCC recurrence even after complete ablation of primary lesions. Because the oncogenic process may be different for hepatitis B viral (B–viral) and hepatitis C viral (C–viral) HCC, the present study was conducted to elucidate the factors contributing to HCC recurrence with respect to the infected hepatitis virus. Two hundred thirty–six patients with a single HCC lesion who underwent complete ablation of the tumor by PEIT and/or PMCT or surgical resection at Tokyo University and its affiliated hospitals from 1993 to 1997 were enrolled. The patients were classified into 3 groups: the B–viral group, C–viral group, and NBNC group. After complete removal of tumors, the patients were followed for a mean period of 39 months. The factors contributing to HCC recurrence were analyzed by univariate and multivariate analysis using the Cox proportional hazard model. The rate of intrahepatic recurrence in enrolled patients at 1, 3, and 5 years was 19%, 50%, and 64%, respectively. The intrahepatic recurrence rate in C–viral and B–viral HCC was higher than that in the NBNC–related HCC. Fibrosis staging, pathological grading of HCC, and serum AFP levels were significantly linked to intrahepatic recurrence by univariate analysis, and fibrosis staging was strongest in the multivariate analysis for C–viral HCC (P = .004). In contrast, fibrosis staging did not affect the recurrence in B–viral (P = .51) and NBNC–related (P = .77) HCC. Risk factors for HCC recurrence differed according to the infected viral state.