Trends and Characteristics of Hepatocellular Carcinoma in Individuals Without Cirrhosis: A Cancer Registry Linked Large Center Study: 2017 Presidential Poster Award

Abstract

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in patients with chronic liver disease and cirrhosis. Historically an estimated 10-20% of HCC develops in the absence of cirrhosis. The burden of liver disease has increased over time and the prevalence of underlying liver diseases has also changed. However, the characteristics of non-cirrhotic HCC are not well-described. The aims of this study were to (i) determine the contribution of non-cirrhotic HCC relative to all HCC seen at our center over time, and (ii) to compare patient and tumor characteristics in non-cirrhotic vs cirrhotic HCC. Methods: Using the State Cancer Registry, we identified all patients with HCC seen at a large academic health center from 2000-2014. Demographic, clinical and tumor characteristics were collected. Patients were categorized as non-cirrhotic (when ascertained with high probability), or as confirmed cirrhotics. The number of non-cirrhotic and cirrhotic HCC cases was determined over 5-year intervals (2000-2004, 2005-2009, and 2010-2014). Patient and tumor characteristics were compared between the groups. Results: During the 15-year study period, 4977 cases of HCC were reported to the Indiana State Cancer Registry, including 1250 subjects seen at least once at our institution. The presence or absence of cirrhosis could not be ascertained in 61 cases. Of the remaining 1189 cases, 135 (11.4%) were non-cirrhotic and 1054 (88.6%) had confirmed cirrhosis. The number of non-cirrhotic HCC cases did not change during the study period, but cirrhotic HCC increased over time (Table 1). Noncirrhotics were older, more frequently female and had more advanced HCC at diagnosis (Table 2). Non-cirrhotics underwent resection rather than liver transplantation more frequently compared to cirrhotics (Table 2). The most common underlying liver disease etiologies in non-cirrhotic HCC were unclear/cryptogenic (42%) and fatty liver (30%). Their frequency did not change over 2000-2004 (43.6% and 33.3%), 2005-2009 (47.4% and 22.8%) and 2010-2014 (30.8% and 38.5%), respectively (p=0.15).Table: Table. Trend of overall, non-cirrhotic and cirrhotic HCC over the study period.Table: Table. Comparison of selected patient and tumor characteristics in non-cirrhotic vs. cirrhotic HCC. Values are shown as mean (standard deviation) or number (percentage).Conclusion: The frequency of non-cirrhotic HCC was unchanged over the last 15 years, while cirrhotic HCC more than doubled. The lack of a screening strategy may explain the advanced stage at diagnosis in non-cirrhotic HCC. However; the association of non-cirrhotic HCC with unclear/cryptogenic or fatty liver disease supports the need for further study of HCC risk factors in patients with metabolic syndrome/fatty liver.