Abstract
Background and Aim: Although cirrhosis is a classical risk factor for the development of hepatocellular carcinoma (HCC), its absence does not exclude this risk. We aimed to assess the clinical characteristics and outcomes of cirrhotic HCC (C-HCC) and non-cirrhotic HCC (NC-HCC) patients. Methods: Patients consecutively included in a prospective HCC cohort (University Hospital Bern) were analysed. They were categorised into two groups, based on the basis of histology or combined radiological and laboratory characteristics. Results: 20.4% of patients were NC-HCC. This group was characterized by a higher median age and a higher female prevalence compared to the C-HCC group. Non-alcoholic fatty liver disease (NAFLD) (25.7%) and HBV infection (14.9%) were the main risk factors in this group, whereas alcohol abuse (26%) and HCV (21.6%) in C-HCC, P<0.001. 19.4% of them were diagnosed during a screening programme. Resection was performed in 54.5% of NC HCC patients despite the advanced stage (BCLC stage B and C). No statistically significant difference in survival rate was observed between C and NC-HCC patients (24 months vs. 33.9 months, P=0.162). In multivariate analysis, in the NC-HCC group each unit increase in BMI was associated with mortality while liver transplantation and resection were positively associated with survival. In the C-HCC group, the BCLC stage C was negatively associated with survival while all the therapeutic lines were negative factors for mortality. Conclusion: NC-HCC patients were diagnosed more often outside a screening programme. The patients were older, with a higher female prevalence and despite an advanced stage, were often amenable to surgery.
Highlights
Hepatocellular carcinoma (HCC) develops on a cirrhotic liver
Non-alcoholic fatty liver disease (NAFLD) (25.7%) and HBV infection (14.9%) were the main risk factors in this group, whereas alcohol abuse (26%) and HCV (21.6%) in C-hepatocellular carcinoma (HCC), P
Recent data suggests that obesity, diabetes, non-alcoholic liver disease (NAFLD), especially in its progressive form (i.e. NASH), are risk factors associated with HCC development [2,3,4,5]
Summary
Hepatocellular carcinoma (HCC) develops on a cirrhotic liver. In the last few decades, it was reported that a certain number of patients develop HCC in non-cirrhotic liver (NC- HCC) [1]. Recent data suggests that obesity, diabetes, non-alcoholic liver disease (NAFLD), especially in its progressive form (i.e. NASH), are risk factors associated with HCC development [2,3,4,5]. This represents an alarming issue, as the NAFLD prevalence globally is high and increasing (from 15% in 2005 to 25% in 2010), while the global prevalence of NASH among biopsied NAFLD patients during the same timeframe has almost doubled [6]. Methods: Patients consecutively included in a prospective HCC cohort (University Hospital Bern) were analysed They were categorised into two groups, based on the basis of histology or combined radiological and laboratory characteristics. The patients were older, with a higher female prevalence and despite an advanced stage, were often amenable to surgery
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