Survival Rate in HBV Related HCC- Experience at Tertiary Care Center of Northeren India

Background: Chronic hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC) worldwide, accounting for over 50% of cases globally. It triggers liver cancer through chronic inflammation (cirrhosis) and direct DNA integration into host cells. Antiviral therapy and vaccination significantly reduce this risk. Reducing liver-related problems, such as HCC, requires effective HBV infection prevention and control techniques. HBV contributes significantly to the development of liver cancer, and our understanding of the variables influencing its carcinogenic potential is expanding. Treatment of HBV infection in individuals with HBV-induced HCC requires special attention due to advances in HCC care. The survival rates vary significantly based on treatment and disease stage, with 5-year overall survival (OS) after radical resection ranging from 20.5% to 64%. Patients receiving curative resection often achieve 1-year survival rates over 90%, while long-term antiviral therapy (NA) is crucial to reducing mortality and recurrence. Material and Methods: The Medical Gastroenterology Department at PGIMS, Rohtak conducted this prospective and retrospective study over a ten-year period, from March 1, 2016, to February 28, 2026. Patients with HBV-related HCC were enrolled in the study after providing written consent. Fifty-four HBV-related HCC patients' data were examined. Data was recovered over the phone if a patient was lost to follow-up. Results: Males and older adults are more likely to have HBV-related H.C.C. Just 4 (7.41%) of the 54 patients were female, while 50 (92.59%) were male. On geographical distribution, there was clear cut predominance of rural background i.e. 51 patients (94.45%) resided in rural area and only 3 patients (5.55%) belonged to urban area. The number of H.C.C. patients in our study group increased with age, with 51 patients (94.45%) being older than 40. The three patients in the third and fourth decades were not cirrhotic; two had a family history of H.C.C. and both had low HBV viral loads; the third patient had chronic hepatitis B with a high viral load and developed multifocal H.C.C. without progressing to the cirrhotic stage. The remaining 51 HBV patients had cirrhosis. Out of total pool of 54 patients of H.C.C, a significant percentage of patients i.e. 25 (46.29%) had low viral load of below 40,000 I.U. or two lakhs copies/ml. The rest 29 patients (53.71%) had high HBV viral load. There was strong association with alcohol and smoking in our study group. Out of total 54 patients, 23 patients (42.59%) consumed both alcohol and smoke, 8 patients (14.81%) were only smoker and 2 patient (3.70%) were only alcoholic. Thus, in total, 33 patients (61.11%) had association with alcohol intake or smoking. Out of total pool of 54 patients, 36 (66.66%) were already diagnosed patients of HBV and were on antiviral treatment and 18 (33.33%) were diagnosed first time as HCC and on aetiological evaluation, were found to be suffering from HBV. Out of these 18 patients, 15 (83.33%) died within six months and only 3 (16.66%) are surviving till date, and all of them have been diagnosed in last one year only. In total 54 patients, 41 (75.92%) have died and only 13 (24.07%) are surviving. Out of these 13 patients who are surviving, 10 (76.92) have been diagnosed in last one year only and only 3 (23.07%) have been diagnosed in last 4-6 years. In these 13 surviving patients, 3 (23.07%) are non-cirrhotic (2 had family history, 1 had advanced fibrosis with high viral load), 6 (46.15%) had compensated cirrhosis and fibroscan improved with antiviral treatment and 4 (30.76%) had decompensated cirrhosis and out of them 2 received TACE (trans-arterial chemo immobilization) therapy. Out of 41 patients who died, only 3 survived for more than five years. Moreover, in 13 patients who are surviving, only 4 patients have been diagnosed for greater than five years and rest 8 have been diagnosed in last one year only. Thus, total five- year survival rate till date is very low i.e. 7 patients out of 54 (12.96%). Conclusion: HBV related HCC can be decreased by effective preventive strategies which includes safe needle practices and hepatitis B vaccination, along with judicious and regular use of antiviral drugs wherever indicated. Patients must take their medications as prescribed, and they should be forbidden from smoking and drinking alcohol, both of which raise the risk of HCC. The HCC patients with metastasis have very short survival of 3- 6 months only. The availability of advanced interventional facilities at government set up is must because majority of these patients belong to poor socio-economic status and cannot bear financial expenses of big corporate hospitals.

Keywords: HBV, Hepatocellular carcinoma, Fibroscan, Endoscopy, HBV Viral load.