Hepatocellular Carcinoma (HCC) arises in chronic liver diseases, particularly caused by hepatitis C virus (HCV) and alcohol in Europe. We aimed at evaluating the characteristics and mortality of patients with HCV-related HCC as compared to other HCC etiologies.
We retrospectively evaluated data from 887 patients with HCC identified through the Hospital del Mar Cancer Registry (Barcelona, Spain), during the 2001–2020 period. We estimated crude and adjusted hazard ratios (aHR) of dying and its 95% confidence interval (95%CI).
Among 887 patients with HCC, 617 (69.6%) were HCV-infected. Underlying cirrhosis was more frequent in HCV-related HCC compared to other etiologies (97% vs. 89%, p < 0.001). The prevalence of HCV-related HCC decreased from 79% in 2001–2005 to 55% in 2015–2020 (p < 0.001). HCV infection did not increase the hazard of death [aHR 0.95 (CI95% 0.81–1.13)]. Mortality was independently related to age > 75 years, advanced BCLC stage at diagnosis, and diagnosis before 2010.
In our cohort, HCV-related HCC frequently occurred in a cirrhotic background, but showed similar clinical characteristics and mortality as compared to other HCC etiologies.
- • Hepatocellular carcinoma (HCC) related to Hepatitis C (HCV) is frequent (~70%).
- • HCC characteristics at diagnosis are similar in HCV positive or negative patients.
- • HCV infection was not related to mortality in HCC patients.
- • HCV-related HCC shows a decreasing incidence through recent years.
Liver cancer is the sixth most common cancer and the second leading cause of cancer-related mortality worldwide . Hepatocellular carcinoma (HCC) arises in the setting of chronic liver diseases (CLD) and represents > 90% of liver cancers . Liver cancer incidence rate varies between geographic regions, according to the prevalence of liver disease risk factors such as hepatitis C virus (HCV), hepatitis B virus (HBV), alcohol consumption, and metabolic-associated fatty liver disease (MAFLD) . Importantly, modelling studies indicate that liver cancer incidence will continue increasing in the next years . Despite MAFLD rise, HCV is still the most prevalent HCC etiology in Western Europe . Based on recent epidemiologic studies, the attributable fraction of HCV-related HCC in Spain is 47–57% .
HCV is a hepatotropic RNA virus related to diverse organic conditions and, specifically, to CLD and HCC . HCV increases HCC 15–20-fold as compared to HCV-negative individuals . However, little is known about the specific clinical characteristics and prognosis of HCV-related HCC as compared to other HCC etiologies. HCV-related HCC appears in a cirrhotic background in > 90% of cases, whereas HBV-related and MAFLD-related HCC can be detected in a non-cirrhotic liver . Also, HCV-related HCC shows distinct molecular features , which can impact its clinical phenotype. However, how these particularities translate into distinct patients’ characteristics or HCC prognosis remains underexplored. Therefore, this study aimed at: (1) comparing the clinical characteristics of HCV and non-HCV-related HCC patients at the time of HCC presentation; (2) assessing prognostic differences between HCV and non-HCV-related HCC, and (3) exploring the evolution of HCV-related HCC patients throughout the years.