Comparison of cryptogenic and hepatitis B related hepatocellular carcinoma

Abstract

INTRODUCTION AND OBJECTIVES: Viral hepatitis is the leading cause for hepatocellular carcinoma (HCC) globally. Cryptogenic or non-alcoholic fatty liver related HCC is increasing and is predominant in Sri Lanka (SL). Few studies have compared cryptogenic (cHCC) and hepatitis B (bHCC) HCC. Objective of the study was to compare cryptogenic and hepatitis B related hepatocellular carcinoma. METHOD: Patients with HCC were screened at two centres, in Hong Kong (HK) and SL, from 2012-2014. HCC was diagnosed on typical CT/MRI appearance. Biopsy was performed when uncertain. Those with safe alcohol intake, no hepatotoxic exposure, and not having viral, autoimmune or inherited aetiology were considered cHCC. Demography, baseline liver status, tumour characteristics and treatment were compared between groups. A p<0.05 was considered significant. RESULTS: There were 891 patients (350-SL,541-HK). All HK patients were HBsAg positive. Two HBsAg positive SL patients, and 363 with unsafe alcohol intake were excluded. There were no hepatitis C patients. cHCC=234 and bHCC=292 were compared. There was no difference in gender, presenting age, symptoms, transaminases, platelet counts, median tumour diameter, morphology and tumour stage at presentation between groups. Significantly more cHCC had diabetes [133 vs. 67], while more bHCC were cirrhotics [269 vs.175]. At presentation, serum bilirubin was significantly higher in bHCC (1.2 vs. 0.7), while INR (1.23vs1.1) and AFP (51u/lvs.26u/l) were significantly higher in cHCC. bHCC had significantly more surgical candidates [113 vs. 50], while significantly more cHCC were transarterial- chemo-embolization (TACE) candidates [74 vs. 53]. More cHCC were unsuitable for active treatment despite similar tumour stage at presentation. CONCLUSIONS: More cHCC had diabetes and occurred in non-cirrhotic livers. Compared to bHCC, fewer cHCC were candidates for surgery or active treatment at presentation.