Hepatocellular Carcinoma in Cirrhotic versus Non-Cirrhotic Liver - Treatment and Survival Differences in a Nationwide Cohort

Abstract

Introduction: Many studies report a superior survival for patients with hepatocellular carcinoma (HCC) in a non-cirrhotic liver compared to HCC in cirrhotic liver. This study aimed to describe clinical presentation, treatment, recurrence and survival differences depending on cirrhosis or non-cirrhosis in a population-based cohort. Method: Patients diagnosed with HCC in Sweden between 2008 and 2018 were identified and extracted from the Swedish Liver registry. Descriptive and survival statistics were applied. Results: A total of 4259 patients were identified of which 1431 (34%) had HCC in a non-cirrhotic liver. Non-cirrhotic patients were older with larger tumor burden at diagnosis. Patients with HCC in a cirrhotic liver were more often planned for (45% vs. 37%, p<0.001) and subsequently underwent curative interventions (40% vs. 31%, p<0.001). If curatively treated, cirrhotic patients underwent transplantation and ablation in 29% and 44% respectively, while 85% of non-cirrhotic patients had a hepatic resection. Recurrence was more common in non-cirrhotic HCC (43% vs. 31%) but were less often treated with a re-intervention (13% vs. 30%). Median survival in cirrhotic patients was 19 months and 13 months in non-cirrhotic HCC, p<0.001. In multivariable analysis, cirrhosis was not an independent predictor of survival, neither among curatively treated patients (p=0.427) nor in the entire cohort (p=0.067). Conclusions: Patients with HCC in cirrhotic liver are treated with curative intent to a greater extent and benefit from a superior survival as compared to patients with HCC in a non-cirrhotic liver due to differences in patient and tumor characteristics rather than cirrhotic status.Tabled 1EP01B-031Univariable and multivariable estimates for overall mortality in patients with hepatocellular carcinoma treated with curative intent Univariable HR (95% CI) p Multivariable HR (95% CI) pAge (years)1.03 (1.02-1.04)<0.0011.02 (1.01-1.03)0.002ECOG >21.20 (0.92-1.56)0.1871.58 (1.18-2.12)0.002Cirrhosis0.82 (0.70-0.98)0.0251.14 (0.83-1.56)0.427No of tumors >41.32 (0.93-1.86)0.1151.49 (0.96-2.30)0.075Size of largest tumor >51 (mm)1.30 (1.06-1.60)0.0141.48 (1.01-2.15)0.042T3-T41.56 (1.19-2.05)0.0011.28 (0.86-1.91)0.227Treatment (transplantation ref.)Hepatic resection2.76 (2.16-3.53)<0.0013.31 (2.18-5.03)<0.001Ablation3.71 (2.89-4.76)<0.0014.52 (3.07-6.64)<0.001 Open table in a new tab