Ak. Tsubota et al., Genotype may correlate with liver carcinogenesis and tumor characteristicsin cirrhotic patients infected with hepatitis B virus subtype adw, J MED VIROL, 65(2), 2001, pp. 257-265
To identify the influence of hepatitis B virus (HBV) genotype on developmen
t of hepatocellular carcinoma (HCC) and clinical outcome in chronic HBV inf
ection, 26 consecutive cirrhotic patients infected with HBV subtype adw wer
e investigated prospectively. HBV serology was undertaken using subtype-spe
cific antibodies against hepatitis B surface antigens. The HBV genotype was
determined by sequencing directly the polymerase chain reaction products o
f the HBV S gene. When HCC occurred, patients underwent transcatheter arter
ial embolization therapy. If tumor necrosis was incomplete, additional embo
lization therapy was carried out after a 3- to 4-month interval. At a media
n follow-up of 14.1 years (range 2.2 to 31.7), HCC occurred in 9 (35%) of 2
6 patients. Nineteen patients were infected with genotype B and 7 with geno
type C. Four of the 19 genotype B patients (21%) and 5 of the 7 genotype C
patients (71%) developed HCC (P=0.058). Patient age (< 45 years or 45 less
than or equal to) at diagnosis of cirrhosis was the only significant indepe
ndent factor influencing liver carcinogenesis by multiple logistic regressi
on analysis and Cox's regression analysis (P = 0.0069 and 0.029, respective
ly). When analysis was limited to the age of 45 years or more at the last v
isit, genotype was the only contributory factor to HCC development by univa
riate analysis (P = 0.038). Whereas genotype B patients responded well to e
mbolization therapy and had no recurrence of HCC for a prolonged period of
time, genotype C patients showed poor responses and died of hepatic failure
due to rapid HCC progression despite embolization therapy. The cumulative
incidence of survival was significantly higher in the genotype B group (P =
0.0049). The HBV genotype correlated with the development of HCC, response
to embolization therapy, and recurrence of HCC. Determination of HBV genot
ype may be useful in predicting outcomes in HBV subtype adw-related cirrhos
is. (C) 2001 Wiley-Liss, Inc.