Comparison Between Alcohol- And Hepatitis B Virus-related Hepatocellular Carcinoma:Clinical Characteristics And Outcome

Background and objectives:Primary liver cancer is one of the most common malignant tumors.It ranks the second in the global cancer mortality.About 600 thousand people die of liver cancer worldwide each year,and half of them in China.Hepatitis B virus?HBV?infection is the main cause of liver cancer in China,but alcohol abuse has gradually become another common cause in recent years.With the application of HBV vaccine,HBV-related hepatocellular carcinoma?HBV-HCC?will decrease continuously,and the proportion of alcohol-related hepatocellular carcinoma?ALC-HCC?will increase.To fully understand the difference between ALC-HCC and HBV-HCC is of great significance for the prevention and control of ALC-HCC.In this study,we observed the differences in clinical features and prognosis between ALC-HCC and HBV-HCC to provide a clinical evidence for prevention and treatment of ALC-HCC.Methods:1.Collection of clinical data:the medical records of 70 patients with alcohol-related hepatocellular carcinoma?ALC-HCC group?and 141 patients with HBV-related hepatocellular carcinoma?HBV-HCC group??a ratio of 1:2 with ALC-HCC?hospitalized in the First Affiliated Hospital of Nanchang University from January 2007 to December 2016 were retrospectively reviewed and the clinical data were collected,including demographic data,past history,laboratory test results,imaging examination,therapy methods.2.Follow-up and condition evaluation:The survival time of each patients was followed by telephone.The Child-Pugh score,BCLC stage,and TNM stage were determined according to the relevant criteria.3.Statistical analysis of clinical data:The differences in clinical characteristics between the two groups were compared by using t-test or chi-square analysis.Kaplan-Meier survival curves were used for survival analysis and Cox forward stepwise regression analysis was used for prognostic factors.The propensity score matching method was used to further compare the differences between the two groups.SPSS 23.0 statistical software was used for data analysis.P<0.05 indicated statistically significant difference.Results:1.Clinical characteristics:two groups of liver cancer patients were male mainly,but the proportion of men in group ALC-HCC was higher?98.6%vs.83.7%?,older?60.50±9.98 years vs.49.55±11.54 years old?,and more accompanied with the history of diabetes and smoking history.The average red blood cell volume,AST/ALT ratio,globulin and GGT in group ALC-HCC were higher than those in group HBV-HCC?P<0.05?,while Child-Pugh score,albumin and cholesterol were lower than those in the HBV-HCC group?P<0.05?.The level of AFP in group ALC-HCC was also significantly lower than that in group HBV-HCC,but the level of CA125 was significantly higher than that in group HBV-HCC?P<0.05?.There was a difference in TNM stage between the two groups?P<0.05?,but there were no differences in tumor size,number,metastasis and BCLC stage.2.Survival time:The median survival time for ALC-HCC patients was 48months,and the 1-,3-,5-,and 7-year survival rates were 61%,55%,41%,and 41%,respectively.For patients in the HBV-HCC group,the median survival time was 32months,and the 1-,3-,5-,and 7-year survival rates were 61%,49%,46%,and 39%,respectively.The difference of survival rates between the two groups was not significant?P>0.05?.After the propensity scores were matched,the median survival time was 43 months,and the 1-,3-,5-,and 7-year survival rates were 61%,54%,40%,and 40%,respectively,in the ALC-HCC group;the median survival time was 15months,and the 1-,3-,5-,and 7-year survival rates were 53%,42%,38%,and 32%,respectively,in HBV-HCC group.There was no significant difference of survival time between the two groups?P>0.05?.3.Prognostic factors of ALC-HCC:before the propensity score matched,univariate analysis showed that age,hypertension,cirrhosis,metastasis,CA125,AST,total bilirubin,albumin/globulin ratio,Na⁺,Child-Pugh score were significantly associated with the prognosis of ALC-HCC patients?P<0.05?;and multivariate analysis by COX regression showed that hypertension,CA125 and Na⁺were independent prognostic factors?P<0.05?.After the propensity score matched,univariate analysis showed that age,hypertension,liver cirrhosis,AST,total bilirubin,direct bilirubin,albumin,globulin,albumin/globulin ratio,Na⁺,CA125,number of tumor,Child-Pugh score,therapy method were significantly associated with the prognosis?P<0.05?;and the multivariate analysis showed that hypertension,Na⁺and CA125 were independent prognostic factors in patients with ALC-HCC?P<0.05?.4.Prognostic factors of HBV-HCC:before the propensity score matched,univariate analysis showed that hypertension,red blood cells,lymphocytes,AST,AST/ALT,total protein,albumin,globulin,albumin/globulin,Ca²⁺,Na⁺,Cr,PT,AFP,CA199,tumor diameter,metastasis,BCLC stage,therapy mehtod,Child-Pugh score were related to prognosis?P<0.05?,and multivariate analysis showed that hypertension,tumor diameter,treatment plan,Child-Pugh score were independent prognostic factors of HBV-HCC?P<0.05?.After the propensity score matched,univariate analysis showed that tumor diameter,AST/ALT,albumin,creatinine,PT,Child-Pugh score,nutrition score were significantly related to prognosis,a nd multivariate analysis showed that Child-Pugh score was a independent prognostic factor of HBV-HCC patients?P<0.05?.5.Prognostic factors of two types of liver cancer:before the propensity score matched,univariate analysis showed that therapy methods,hypertension,tumor number,tumor diameter,metastasis,lymphocyte,red blood cell volume,red blood cell,AFP,CA199,total bilirubin,albumin,AST/ALT,Na⁺,Ca²⁺,PT,Child-Pugh score,nutritional score,BCLC stage,tumor TNM stage were significantly related to prognosis?P<0.05?,and multivariate analysis showed that hypertension,CA199,tumor diameter,therapy mehtod were independent prognostic factors?P<0.05?.After the propensity scores were matched,univariate analysis showed that hypertension,a history of cirrhosis,AST,total bilirubin,conjugated bilirubin,albumin,globulin,albumin/globulin ratio,Na⁺,Cr,PT,CA125,tumor diameter,Child-Pugh score,nutritional score,and therapy method were significantly associated with prognosis?P<0.05?,and multivariate analysis showed that hypertension,Na⁺,tumor diameter,and Child-Pugh score were independent prognostic factors?P<0.05?.Conclusions1.Compared with HBV-HCC,the patients with ALC-HCC have higher male proportion?almost all males?,larger age of occurrence,and worse liver function at the time of diagnosis.2.Compared with HBV-HCC,patients with ALC-HCC have lower levels of AFP and higher levels of CA125.3.Hypertension,CA125,and Na⁺are independent prognostic factors in patients with ALC-HCC,and hypertension,tumor diameter,and Child-Pugh score are independent prognostic factors for HBV-HCC patients.