Effect of hepatitis C virus (HCV) on the outcome of hepatocellular carcinoma (HCC).

e15634 Background: HCV infection is a major cause of HCC in the United States. In previous published subset analysis of HCC subjects treated with sorafenib, HCV subjects had better outcome. To evaluate the effect of HCV infection on survival in HCC and the interaction with local and systemic therapies, a retrospective cohort analysis of subjects in VA population was conducted. Methods: Veterans with HCC were identified from the VISN 16 tumor-registry from 2007-2012. Tumor stage, etiology of HCC [Hepatitis B virus (HBV), HCV, and non-viral causes], treatment received and outcome were collected. Results: 1035 HCC subjects were identified. Median age was 60 years (range 43-93); 99.4% were male; 63.4% Caucasian, 34.6% African-American. 76.4% had history of alcohol use; 47.3% were positive for Hepatitis C, 2.1% for Hepatitis B, and 1.1% for both. Subjects with HBV (N=34) were excluded from analysis due to their small number. Of the remaining 1001 subjects, 53.3% received no therapy, 16.2% received Sorafenib, 24.9% received loco-regional therapy (LRT) with radiofrequency ablation, trans-arterial chemo embolization (TACE), or ethanol injection, alone or in combination, and 5.7% had surgical resection. HCV subjects had a 19% reduction in mortality compared to uninfected subjects (HR=0.81; p=0.0028). The effect of HCV infection on overall survival within treatment subgroups is shown in the table. Conclusions: HCC subjects with hepatitis C appear to have better survival compared to those with other noninfectious etiologies. The beneficial effect was seen only in subjects who did not receive any therapy, probably from HCV having an effect on the natural history of the disease. The lack of evident effect in those who received Sorafenib, LRT and resection, may be due to small numbers and interaction with other influencing factors affecting such therapies. Therapy Total With HCV Median Survival, Months P N N (%) With hepatitis C No hepatitis No Treatment 533 246 (46) 8.1 3.8 0.036 Sorafenib Only 162 71 (43) 7.4 8.6 0.40 Loco-regional Therapy* 249 143 (57) 30.7 27.0 0.64 Resection/Lobectomy$ 57 30 (53) 56.4 60.1 0.85 *21 subjects also received Sorafenib. $13 subjects also had TACE, 5 received Sorafenib, 1received both.