Hepatocellular carcinoma in hepatitis D: does it differ from hepatitis B monoinfection?

ABSTRACT

Hepatitis D virus [HDV] superinfection in patients with chronic hepatitis B leads to accelerated liver injury, early cirrhosis, and decompensation. It may be speculated that hepatocellular carcinoma [HCC] may differ in these patients from hepatitis B virus [HBV] monoinfection. The aim of this study was to compare clinical aspects of hepatocellular carcinoma in patients of hepatitis D with HBV monoinfection. A total of 92 consecutive HCC cases seropositive for antibody against HDV antigen [HDV group] were compared with 92 HBsAg-positive and anti-HDV-negative cases [HBV group]. The features including sex, body mass index, presence of ascites, serum biochemistry, gross tumor appearance, child class, barcelona cancer liver clinic and okuda stages were not significantly different between the 2 groups. Decreased liver size was noticed more in cases of HDV compared with HBV group where the liver size was normal or increased [P=0.000]. HDV patients had lower platelets [P=0.053] and larger varices on endoscopy [P=0.004]. Multifocal tumors and elevated alpha-fetoprotein level>1000 IU/mL were more common in HBV group [P=0.040 and P=0.061]. TNM classification showed more stage III-IV disease in HBV group [P=0.000]. Decreased liver size and indirect evidence of more severe portal hypertension and earlier TNM stage compared with HBV monoinfection indicate that HDV infection causes HCC in a different way, possibly indirectly by inducing inflammation and cirrhosis