Year 2019 / Volume 111 / Number 10
Original
Characteristics and survival of hepatocellular carcinoma in non-cirrhotic liver

760-766

DOI: 10.17235/reed.2019.6180/2018

Marta Romero-Gutiérrez, María Abanades Tercero, Juan Ruiz Martín, Juan Diego Castro Limo, Tomás Artaza Varasa, Concepción González de Frutos, Gema de la Cruz Pérez, Juan José Sánchez Ruano, Ana Zaida Gómez Moreno, Rafael Gómez Rodríguez,

Abstract
Introduction: the characteristics, screening, and survival of hepatocellular carcinoma (HCC) for patients without cirrhosis have not been fully studied. Methods: A retrospective cohort study was performed in non-cirrhotic patients with histological HCC, between January 2004 and October 2018. Their characteristics, treatment, follow-up and overall survival were described. Results: 25 of the 332 patients with HCC met the inclusion criteria (7.5%), 76% were males and the median age was 69.9 years. The main etiology of liver disease was the hepatitis B virus (HBV) (32%), followed by non-alcoholic steatohepatitis (NASH) (20%). Liver fibrosis was mild (0-1) in 44% of cases. The nodule was diagnosed by ultrasonography in 32% of cases, 60% were found incidentally and 8% due to clinical symptoms. The Barcelona Clinic Liver Cancer (BCLC) staging was 0 in 4% of cases, A in 88%, B in 4% and C in 4%. The main initial treatment was surgical resection (76%) and 8% refused to be treated. Percutaneous ethanol injection, chemoembolization, sorafenib and palliative care were each performed in 4% of cases. There were some complications in 21% of patients treated with surgery, half of them were severe. The median follow-up was 22.2 (2.9-150.6) months and 56% were in remission and the median overall survival was 57.4 ± 29.8 months. The overall cumulative survival at 1, 3 and 5 years was 84%, 61.6% and 47.9%, respectively. Conclusion: 7.5% of HCC presented without cirrhosis and almost half of patients had mild fibrosis. HBV was the main cause of HCC, followed by NASH. The most frequent BCLC stage at diagnosis was early stage and surgery was the most common treatment. Overall cumulative survival at 5 years was almost 50%.
Share Button
New comment
Comments
No comments for this article
References
1. European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56(4):908-43.
2. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018;67(1):358-80.
3. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet 2018;391(10127):1301-14.
4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69(1):182-236.
5. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology 2005;42:1208-36.
6. Baffy G, Brunt EM, Caldwell SH. Hepatocellular carcinoma in nonalcoholic fatty liver disease: an emerging menace. J Hepatol 2012;56:1384-91.
7. Schütte K, Schulz C, Poranzke J, et al. Characterization and prognosis of patients with hepatocellular carcinoma (HCC) in the non-cirrhotic liver. BMC Gastroenterol 2014;14:117.
8. Mohamad B, Shah V, Onyshchenko M, et al. Characterization of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) patients without cirrhosis. Hepatol Int 2016;10(4):632-9.
9. Giannini EG, Marenco S, Bruzzone L, et al. Hepatocellular carcinoma in patients without cirrhosis in Italy. Dig Liver Dis 2013;45(2):164-9.
10. Shimada M, Rikimaru T, Sugimachi K, et al. The importance of hepatic resection for hepatocellular carcinoma originating from nonfibrotic liver. J Am Coll Surg 2000;191(5):531-7.
11. Chang CH, Chau GY, Lui WY, et al. Long-term results of hepatic resection for hepatocellular carcinoma originating from noncirrhotic liver. Arch Surg 2004; 139 (3): 320-5.
12. Moya A, López-Andújar R, San Juan F, et al. Patrones de calidad en el manejo del carcinoma hepatocelular mediante resección hepática: criterios de selección y resultados en una unidad de referencia de cirugía hepatobiliar. Cir Esp 2004;76(2):101-6.
13. Faber W, Sharafi S, Stockmann M, et al. Patient age and extent of liver resection influence outcome of liver resection for hepatocellular carcinoma in non-cirrhotic liver. Hepatogastroenterology 2014;61(135):1925-30.
14. Faber W, Sharafi S, Stockmann M, et al. Long-term results of liver resection for hepatocellular carcinoma in noncirrhotic liver. Surgery 2013;153(4):510-7.
15. Zhou Y, Lei X, Wu L, et al. Outcomes of hepatectomy for nonchirrotics hepatocellular carcinoma: a systemic review. Surg Oncol 2014;23(4):236-42.
16. Nuñez O, Matilla A, Merino B, et al. Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico. Gastroenterol Hepatol 2011;34(5):322-8.
17. Díaz-González A, Forner A, Rodríguez de Lope C, et al. Nuevos retos en la investigación clínica del carcinoma hepatocellular. Rev Esp Enferm Dig 2016;8(108):485-93
18. Rodríguez de Lope C, Reig M, Matilla A, et al. Características clínicas del carcinoma hepatocelular en España. Comparación con el período 2008-2009 y análisis de las causas de diagnóstico fuera de los programas de detección. Análisis de 686 casos en 73 centros. Med Clin (Barc) 2017;149(2):61-71.
19. European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63(1):237-64.
20. Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol 2010;53:1013–21.
21. The French METAVIR Cooperative Study Group. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology 1994;20(1 Pt 1):15-20.
22. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24(2):289-93.
23. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954;7:462–503.
24. Dyson J, Jaques B, Chattopadyhay D, et al. Hepatocellular carcinoma: The impact of obesity, type 2 diabetes and a multidisciplinary team. J Hepatol 2014;60:110-7.
25. Kanwal F, JR Kramer, Duan Z, et al. Trends in the Burden of Nonalcoholic Fatty Liver disease in a United States Cohorts of Veterans. Clin Gastroenterol Hepatol 2016;14(2):301-8.
26. Schlesinger S, Aleksandrova K, Pischon T, et al. Diabetes mellitus, insulin treatment diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort. Ann Oncol 2013; 24:2449-55.
27. Trevisani F, Frigerio M, Santi V, et al. Hepatocellular carcinoma in non-cirrhotic liver: a reappraisal. Dig Liver Dis 2010;42(5):341-7.
28. Grazi GL, Cescon M, Ravaioli M, et al. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for longs-term survival and tumour recurrence in a single center. Aliment Pharmacol Ther 2003;17(Suppl 2):119-29.
29. Yasui K, Hashimoto E, Komorizono Y, et al Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol 2011;9(5):428-33.
30. Leung C, Yeoh SW, Patrick D, et al. Characteristics of hepatocellular carcinoma in cirrhotic and non-cirrhotic non-alcoholic fatty liver disease. World J Gastroenterol 2015;21(4):1189-96.
31. Arnaoutakis DJ, Mavros MN, Shen F, et al. Recurrence patterns and prognostic factors in patients with hepatocellular carcinoma in noncirrhotic liver: a multi-institucional analysis. Ann Surg Oncol 2014;21:147-54.
32. Tampaki M, Savvanis S, Koskinas J. Impact of direct-acting antiviral agents on the development of hepatocellular carcinoma: evidence and pathophysiological issues. Ann Gastroenterol 2018;31(6):670-79.
33. Cabibbo G, Celsa C, Cammà C, Craxì A.Should we cure hepatitis C virus in patients with hepatocelular carcinoma while treating cancer? Liver Int 2018;38(12):2108-16.
34. Chiappini F, Gross-Goupil M, Saffroy R, et al. Microsatellite instability mutator phenotype in hepatocelular carcinoma in non-alcoholic and non-virally infected normal livers. Carcinogenesis 2004;25(4):541-7.
35. Di Martino M, Saba L, Bosco S, et al. Hepatocellular carcinoma (HCC) in non-cihrrotic liver: clinical, radiological and pathological findings. Eur Radiol 2014;24(7):1446-54.
36. Mergental H, Adam R, Ericzon BG, et al. Liver transplantation for unresectable hepatocellular carcinoma in normal livers. J Hepatol 2012;57(2):297-305.
37. Decaens T, Laurent A, Luciani A. Liver transplantation for hepatocellular carcinoma in non-cirrhotic livers regardless of the number and size of tumours? J Hepatol 2012;57(2):235-6.
38. Lang H, Sotiropoulos GC, Domland M, et al. Liver resection for hepatocellular carcinoma in non-cihrrotic liver without underlying viral hepatitis. Br J Surg 2005;92198-202.
39. Laurent C, Blanc JF, Nobili S, et al. Prognostic factors and long-term survival after hepatic resection for hepatocellular carcinoma originating from noncirrhotic liver. J Am Coll Surg 2005;201(5):656-62.
40. Wörns MA, Bosslet T, Victor A, et al. Prognostics factors and outcomes of patients with hepatocellular carcinoma in non-cirrhotic liver. Scand J Gastroenterol 2012;47(6):718-28.
41. Taura K, Ikai I, Hatano E, et al. Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery 2007;142(5):685-94.
42. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrosis. N Engl J Med 1996; 334(11):693-9.
43. Clavien PA, Lesurtel M, Bossuyt PM, et al. OLT for HCC Consensus Group. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 2012;13(1):e11-22.
44. Lubrano J, Huet E, Tsilividis B, et al. Long-term outcme of liver resection for hepatocellular carcinoma in noncirrhotic nonfibrotic liver with no viral heatitis or alcohol abuse. World J Surg 2008;32(1):104-9.
Related articles

Editorial

Hemophilia and hepatology, back to the future

DOI: 10.17235/reed.2024.10105/2023

Digestive Diseases Image

Giant cystic hepatocarcinoma in the absence of cirrhosis

DOI: 10.17235/reed.2021.8313/2021

Letter

Biopsy for hepatocellular carcinoma: only occasionally

DOI: 10.17235/reed.2020.6935/2020

Letter

Hepatocarcinoma diagnosis. Reflection is required

DOI: 10.17235/reed.2020.6845/2019

Letter

Rhabdomyolysis in a patient under treatment with sorafenib

DOI: 10.17235/reed.2020.6440/2019

Case Report

Ectopic hepatocellular carcinoma arising from the peritoneum

DOI: 10.17235/reed.2019.6408/2019

Digestive Diseases Image

Debut of an unusual liver cirrhosis

Review

New challenges in clinical research on hepatocellular carcinoma

DOI: 10.17235/reed.2015.4012/2015

Citation tools
Romero-Gutiérrez M, Abanades Tercero M, Ruiz Martín J, Castro Limo J, Artaza Varasa T, González de Frutos C, et all. Characteristics and survival of hepatocellular carcinoma in non-cirrhotic liver. 6180/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1507 visits.
This article has been downloaded 371 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 17/01/2019

Accepted: 16/03/2019

Online First: 09/09/2019

Published: 03/10/2019

Article revision time: 47 days

Article Online First time: 235 days

Article editing time: 259 days


Share
This article has been rated by 3 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology