Anti-HCV positive hepatocellular carcinoma in cirrhosis. Prevalence, risk factors and clinical features.

Recent reports indicate that hepatitis C virus (HCV) may play a role in the pathogenesis of hepatocellular carcinoma in cirrhotics. Using an ELISA test, we evaluated the prevalence of anti-HCV antibodies in 97 patients with hepatocellular carcinoma (HCC) in cirrhosis and in a group of 223 patients, including: 49 patients with HBsAg-positive chronic liver disease (CLD), 42 with alcoholic CLD, 110 with cryptogenic CLD and 22 with post-transfusional HBsAg-negative CLD. All diagnoses were histologically confirmed. Overall, anti-HCV-positive HCC were 64% of the total, with no statistically significant difference with respect to CLD (60.9%). The prevalence of anti-HCV was higher in cryptogenic HCC (80%) than in HBsAg-positive (60%) or alcoholic HCC (42.8%) (p < 0.005). When HCC and cirrhosis of similar putative etiology were considered, anti-HCV prevalence was significantly higher in HCC than in cirrhosis only in the groups of patients with alcoholic liver damage (60% in HCC vs. 38% in cirrhosis, p < 0.005). In HBsAg-positive patients, anti-HCV prevalence was twice as high in HCC than in CLD, but the difference was not statistically significant. Overall, anti-HCV prevalence in HCC was significantly higher than in alcoholic or HBsAg-positive CLD (p < 0.001 and p < 0.01, respectively) but lower than in cryptogenic CLD (p < 0.001). Association between anti-HCV and anti-HBc was significantly more prevalent in patients with CLD than in those with HCC. From the clinical point of view, multifocal lesions and lack of a history of previous liver disease were more frequent in anti-HCV-positive HCC (p < 0.05) than in HBsAg-positive or alcoholic patients. Anti-HCV-positive HCC had a significantly worse prognosis (p < 0.005 with the Generalized Wilcoxon-Breslow test), when survival in the different subgroups was examined with life table analysis. No statistically significant differences were observed with respect to the remaining parameters considered. In conclusion, HCV infection appears to be a frequent event in HCC and CLD, particularly in patients with cryptogenic liver disease but, with the exception of patients with alcoholic liver damage, the prevalence of anti-HCV appears to be similar in HCC and cirrhosis. This could indicate that the infection plays an important role only in specific subgroups of HCC patients. Anti-HCV-positive HCC is frequently diagnosed in a more advanced stage and has a worse prognosis but, since the clinical history of this subgroup of patients frequently makes its debut with HCC, in our opinion the prognosis is worse due to late diagnosis.