Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 58-68
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.58
Correlation between smoking habit and surgical outcomes on viral-associated hepatocellular carcinomas
Keita Kai, Sho Komukai, Hiroki Koga, Koutaro Yamaji, Takao Ide, Atsushi Kawaguchi, Shinichi Aishima, Hirokazu Noshiro
Keita Kai, Shinichi Aishima, Department of Pathology, Saga University Hospital, Saga 849-8501, Japan
Sho Komukai, Clinical Research Center, Saga University Hospital, Saga 849-8501, Japan
Hiroki Koga, Koutaro Yamaji, Takao Ide, Hirokazu Noshiro, Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
Koutaro Yamaji, Shinichi Aishima, Department of Pathology and Microbiology, Saga University Faculty of Medicine, Saga 849-8501, Japan
Atsushi Kawaguchi, Center for Comprehensive Community Medicine, Saga University Faculty of Medicine, Saga 849-8501, Japan
Author contributions: Kai K, the main author of this article, designed the study, conducted the data collection, and contributed to the statistical analyses; Komukai S and Kawaguchi A performed the statistical analyses; Koga H, Yamaji K, and Ide T contributed to the data collection; Aishima S and Noshiro H contributed to the data collection and reviewed the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The protocol of this study was reviewed and approved by the Ethics Committee of the Faculty of Medicine at Saga University.
Informed consent statement: Informed consent for the use of resected tissue and medical information was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Keita Kai, MD, PhD, Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga City, Saga 849-8501, Japan.
Telephone: +81-952-343264 Fax: +81-952-342055
Received: October 26, 2017
Peer-review started: October 27, 2017
First decision: November 21, 2017
Revised: December 2, 2017
Accepted: December 12, 2017
Article in press: December 12, 2017
Published online: January 7, 2018
Research background

Although cigarette smoking has been recognized as one of the risk factors for hepatocellular carcinoma (HCC), the surgical outcomes and clinicopathological characteristics according to smoking habits of HCC patients remains unclear. We investigate the association between smoking status and surgical outcomes in hepatitis B virus-related HCC (B-HCC) and HCV-related HCC (C-HCC).

Research motivation

We recently analyzed the relationship between smoking status and surgical outcomes in patients with non-B non-C (NBNC)-HCC, and our analysis revealed that smoking habits are significantly correlated with the curatively resected surgical outcomes of NBNC-HCC. We then speculated that if smoking habits truly affect the postoperative prognosis of HCC, smoking habits might also affect the postoperative prognosis of viral-associated HCC patients.

Research objectives

We conducted the present study to investigate the association between smoking habits and surgical outcomes in B-HCC and C-HCC patients who underwent curative surgery, and clarify the clinicopathological features associated with smoking habits in patients with B-HCC or C-HCC.

Research methods

Cases of the 341 consecutive patients with viral-associated HCC (C-HCC, n = 273; B-HCC, n = 68) who underwent curative surgery for their primary lesion were retrospectively examined. We categorized smoking status at the time of surgery into never, ex- and current smoker and analyzed the clinicopathological features and surgical outcomes, i.e., disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS).

Research results

The multivariate analysis in the C-HCC group revealed that current-smoker status was significantly correlated with both OS and DSS. No significant correlation was observed between current-smoker status and DFS, OS, or DSS in the B-HCC patients of the univariate or multivariate analyses.

Research conclusions

Smoking habit is significantly correlated with the overall and disease-specific survivals of patients with C-HCC, and in contrast, the B-HCC patients showed a weak association between smoking status and surgical outcomes.

Research perspectives

The results of this study support the hypothesis that smoking-associated HCC is with is high malignant potential. It would be a motivation for further research. We expect future research clarify the mechanism of carcinogenesis of HCC via smoking. Our results also can be expected to provide further motivation for smoking cessation.