Early Fibrosis but Late Tumor Stage and Worse Outcomes in Hepatocellular Carcinoma Patients Without Hepatitis B or Hepatitis C

Dig Dis Sci. 2020 Jul;65(7):2120-2129. doi: 10.1007/s10620-019-05938-3. Epub 2019 Nov 13.

Abstract

Background and aims: The features of non-viral, nonalcohol hepatocellular carcinoma (NBNC-HCC) remain elusive. The aim of this study was to investigate this clinical characteristics and overall survival of NBNC-HCC compared to hepatitis B- (HBV-HCC) and hepatitis C-related (HCV-HCC) HCC.

Methods: We analyzed the etiologies, fibrosis stages, clinical data, and outcomes of newly diagnosed patients with HCC.

Results: A total of 1777 HCC patients were recruited, including 332 patients with NBNC-HCC, 682 patients with HBV-HCC, 680 patients with HCV-HCC, and 83 patients with HBV/HCV HCC. Patients with NBNC-HCC were older (69.9 ± 11.9 years). Patients with NBNC-HCC exhibited a higher prevalence of diabetes (43.9%) compared to the HBV-HCC (27.1%, p < 0.05) and HCV-HCC (30.2%, p < 0.05) groups. Compared to patients from the viral-related HCC groups, patients with NBNC-HCC exhibited a significantly lower fibrosis stage. NBNC-HCC patients exhibited a higher proportion of Barcelona Clinic Liver Cancer (BCLC) classification stage C and stage D compared to patients from the HBV-HCC and HCV-HCC groups. With a mean of 2.33 ± 2.31 years of follow-up, the median survival of patients with NBNC-HCC was 1.75 (95% CI 1.33-2.17) years, which was significantly lower than that of patients with HBV-HCC (p = 0.041) and HCV-HCC (p < 0.001).

Conclusions: Patients with NBNC-HCC have a higher risk of diabetes than patients with HCC of viral etiologies. Although patients with NBNC-HCC exhibited a milder fibrosis stage, their more advanced HCC stages and worse overall survival should be taken into consideration in clinical care.

Keywords: Cancer staging; Hepatocellular carcinoma; Liver fibrosis; Nonalcoholic fatty liver disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alanine Transaminase / blood
  • Antineoplastic Agents / therapeutic use
  • Aspartate Aminotransferases / blood
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / etiology
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / therapy*
  • Catheter Ablation
  • Chemoembolization, Therapeutic
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Female
  • Hepatectomy
  • Hepatitis B, Chronic / complications
  • Hepatitis C, Chronic / complications
  • Humans
  • Hypertension / epidemiology
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / pathology*
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / etiology
  • Liver Neoplasms / pathology
  • Liver Neoplasms / therapy*
  • Liver Transplantation
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Obesity / epidemiology
  • Platelet Count
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Radiotherapy
  • Serum Albumin / metabolism
  • Severity of Illness Index
  • Sorafenib / therapeutic use
  • Survival Rate

Substances

  • Antineoplastic Agents
  • Serum Albumin
  • Sorafenib
  • Aspartate Aminotransferases
  • Alanine Transaminase