Prognosis of Hepatocellular Carcinoma: Impact of the Etiology of Cirrhosis

Research Article

Austin Hepatol. 2019; 4(1): 1010.

Prognosis of Hepatocellular Carcinoma: Impact of the Etiology of Cirrhosiss

Sabbah M*, Trad D, Ouakaa A, Bibani N, Elloumi H and Gargorui D

Department of Gastroenterology, Habib Thameur Hospital, Tunisia

*Corresponding author: Sabbah Meriam, Department of Pathology, Habib Thameur Hospital, Rue Ali Ben Ayed, Montfleury, 1008, Tunis, Tunisia

Received: September 13, 2019; Accepted: October 14, 2019; Published: October 21, 2019


Introduction: In Tunisia, the main etiology of cirrhosis remains viral hepatitis. Hepatocellular Carcinoma (HCC) is a major cause of mortality during cirrhosis. Its prognosis depends on several factors. The aim of this study was to compare HCC occurring on viral and non-viral cirrhosis and to determine the impact of the etiology of cirrhosis on the prognosis and survival of HCC.

Patients and Methods: A comparative retrospective study including 93 patients (January 2002 - December 2016) was performed. Patients were divided into two groups according to the etiology of their cirrhosis: group 1: patients with HCC du to viral cirrhosis and group 2: patients with HCC due to non-viral cirrhosis. Epidemiological, clinical, biological, radiological, therapeutic parameters as well as survival were compared between the two groups.

Results: Ninety-three patients with HCC (mean age 66.18 years (43-90 years) and sex ratio 1.66) were included. Cirrhosis was viral (group 1) in 68 (73%) and non-viral (group 2) in 25 (27%) patients. There were no differences in age, sex, history, habits or clinical signs. However, HCC was more frequently discovered during screening in group 1 (p=0.001). A higher level of GGT and PAL was observed in group 1 (p respectively=0.021 and 0.004). Moreover, higher tumoral size of HCC was noted in group 1 (45mm versus 31mm with p ‹0.0001). OKUDA and BCLC scores were higher in group 1 (p=0.018 and 0.020). Symptomatic treatment was more frequently indicated in group 1 (p=0.021). Finally, mean survival in both groups was respectively 4 months and 10 months (p=0.011) with a higher survival at 6 and 18-month in group 2 (p=0.047 and 0.05).

Conclusion: In our study, viral cirrhosis was correlated with more advanced HCC as evidenced by higher tumoral size and elevated prognostic scores. Survival was thus lower in the group of viral cirrhosis. With the recent development of anti-viral therapies, the impact of the etiological treatment of cirrhosis on the evolution of HCC should be assessed.

Keywords: Hepatocellular Carcinoma; Prognosis; Hepatitis


Cirrhosis caused by Hepatitis B Virus (HVB) or Hepatitis C Virus (HCV) [1] are responsible for the majority of cases of Hepatocellular Carcinoma (HCC) [2]. The etiology of cirrhosis appears than to influence phenotypic and evolutive characteristics, as well as the prognosis and survival during HCC.

The aim of our study was to compare HCC occurring in viral and non-viral cirrhosis and to assess the impact of the etiology of cirrhosis on prognosis and survival during HCC.

Patients and Methods

A retrospective analytical study including all HCC on hepatic cirrhosis was conducted. Patients were followed in the gastroenterology department of Habib Thameur Hospital during a period of 15 years (January 2002 - December 2016).

Patients were divided into two groups according to the etiology of their cirrhosis:

• Group 1: patients with HCC on viral cirrhosis (due to hepatitis B or C).

• Group 2: patients with a HCC on cirrhosis of other etiology.

Cirrhosis was diagnosed on clinical, biological (prothrombin time, platelets, albumin and fibrotic markers), endoscopic (oesophageal varices), and morphological signs.

The diagnosis of HCC, due to the evolution of the diagnostic criteria, was made, according to the date of diagnosis, on the Barcelona criteria of 2000 [3], the AASLD (American Association for The Study of Liver Diseases) criteria of 2005 [4] and 2011 [5] and finally, on the EASL (European Association for The Study of Liver) criteria of 2012 [6].

Patients with HCC on non-cirrhotic liver (healthy liver or chronic hepatitis) and patients whose hospital records were either unexploitable or not found were not included in our study.

Patients whose follow-up was less than 6 months were excluded from the survival study.

Epidemiological, clinical, biological, morphological, therapeutic and outcome data, as well as survival, were collected and compared between the two groups.

Statistical analysis was done by SPSS 23.0 software. Comparison of qualitative variables was performed by the Pearson Chi 2 test. Comparison of quantitative variables was performed by Student’s t-test. Survival was assessed according to the Kaplan-Meier method with comparison of survival rates by the Log Rank test.

In all statistical tests, the significance level was set at 0.05.


Descriptive study

During the study period, 105 patients with HCC were recorded. Twelve patients were excluded: four patients had HCC on healthy liver and two on chronic hepatitis. The remaining 6 patients were excluded due to missing data or unusable records. Thus, only 93 cases were included (Figure 1).