Aliment Pharmacol Ther. 2019 Sep 1. doi: 10.1111/apt.15464. [Epub ahead of print]
Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study.
Gawrieh S1, Dakhoul L1, Miller E2, Scanga A3, deLemos A4, Kettler C1, Burney H1, Liu H1, Abu-Sbeih H2, Chalasani N1, Wattacheril J5.
Author information
1
Indiana University School of Medicine, Indianapolis, Indiana.
2
MD Anderson Cancer Center, Houston, Texas.
3
Vanderbilt University School of Medicine, Nashville, Tennessee.
4
Atrium Health, Charlotte, North Carolina.
5
Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Abstract
BACKGROUND:
Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States.
AIM:
To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres METHODS: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria.
RESULTS:
Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P < .001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P < .0001]) and NAFLD (0.66% [P = .003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P < .001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P = .004).
CONCLUSIONS:
Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.