Abstract
A recent study from the United States reported that nearly 12% of hepatocellular carcinomas (HCCs) occurred in patients without cirrhosis. Non-alcoholic fatty liver disease (NAFLD) was the most common liver disease in these patients. We aim to evaluate the characteristics, etiologies, and outcomes of cases of non-cirrhotic HCC in East Asia, where there is a higher prevalence of hepatitis B virus (HBV)-associated non-cirrhotic HCC. This retrospective study consecutively enrolled de novo HCC patients managed at our institution from 2011 to 2017. The presence of cirrhosis was assessed by histology; if histology was not available, it was assessed by image study. 2055 patients with HCC were enrolled in this study. Among them, 529 (25.7%) were non-cirrhotic. The non-cirrhotic patients were younger (60.9 vs. 62.5 years, p = 0.006), included a greater proportion of males (78.1% vs. 71.3%, p = 0.002), and had a lower body mass index (24.3 vs. 25.3 kg/m2, p<0.001) than the cirrhotic patients. Among the non-cirrhotic patients, HBV was the most common liver disease (49.0%). The patients with non-cirrhotic HCC had larger tumors (5.9 vs. 4.7 cm, p<0.001), underwent liver resection at a higher rate (66.0% vs. 17.4%, p<0.001), and had better overall survival than the cirrhotic HCC patients (median 5.67 vs. 2.83 years, p<0.001). Nearly 26% of the HCCs occurred in patients without cirrhosis. HBV was the most common liver disease in these patients, and the survival was better in the non-cirrhotic patients than the cirrhotic patients.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer death worldwide [1,2]
We aim to evaluate the characteristics, etiologies, and outcomes of cases of noncirrhotic HCC in East Asia, where there is a higher prevalence of hepatitis B virus (HBV)associated non-cirrhotic HCC
26% of the HCCs occurred in patients without cirrhosis
Summary
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer death worldwide [1,2]. A recent study from the United States (US) reported, that nearly 12% of HCCs occurred in patients without cirrhosis, with NAFLD being the most common liver disease in these patients [9]. It is unclear whether the rising incidence of NAFLD globally has resulted in higher numbers of non-cirrhotic NAFLD-associated HCCs, especially in HBV endemic areas where the leading etiology of non-cirrhotic HCC is HBV. We aimed to evaluate (1) the characteristics and frequency of non-cirrhotic HCC, (2) the contribution of NAFLD-associated HCC to the burden of non-cirrhotic HCC, and (3) the treatment modalities applied to non-cirrhotic HCC patients and their survival compared with cirrhotic patients with HCC
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