TY - JOUR
AR - JSO-2020-6-107
TI - Hepatocellular Carcinoma in Cirrhotic Versus Non-Cirrhotic Patients: A Retrospective Study of 483 Patients
AU - Pompilia, Radu
AU - Guillaume , Aeby
AU - Birgit , Schwacha-Eipper
AU - Philippe , Kolly
AU - Codruta , Mare
AU - Vanessa , Banz
AU - JeanFrançois , Dufour
JO - Journal of Surgical Oncology
PY - 2020
DA - Mon 08, Feb 2021
SN - 2674-3000
DO - http://dx.doi.org/10.31487/j.JSO.2020.06.07
UR - https://www.sciencerepository.org/hepatocellular-carcinoma-in-cirrhotic-versus-non-cirrhotic-patients_JSO-2020-6-107 
KW -  Hepatocellular carcinoma, non-cirrhotic hepatocellular carcinoma, cirrhotic hepatocellular carcinoma, non-alcoholic fatty liver disease, surveillance, survival
AB - Background and Aim: Although cirrhosis is a classical risk factor for the development of hepatocellular
carcinoma (HCC), its absence does not exclude this risk. We aimed to assess the clinical characteristics and
outcomes of cirrhotic HCC (C-HCC) and non-cirrhotic HCC (NC-HCC) patients.
Methods: Patients consecutively included in a prospective HCC cohort (University Hospital Bern) were
analysed. They were categorised into two groups, based on the basis of histology or combined radiological
and laboratory characteristics.
Results: 20.4% of patients were NC-HCC. This group was characterized by a higher median age and a
higher female prevalence compared to the C-HCC group. Non-alcoholic fatty liver disease (NAFLD)
(25.7%) and HBV infection (14.9%) were the main risk factors in this group, whereas alcohol abuse (26%)
and HCV (21.6%) in C-HCC, P<0.001. 19.4% of them were diagnosed during a screening programme.
Resection was performed in 54.5% of NC HCC patients despite the advanced stage (BCLC stage B and C).
No statistically significant difference in survival rate was observed between C and NC-HCC patients (24
months vs. 33.9 months, P=0.162). In multivariate analysis, in the NC-HCC group each unit increase in
BMI was associated with mortality while liver transplantation and resection were positively associated with
survival. In the C-HCC group, the BCLC stage C was negatively associated with survival while all the
therapeutic lines were negative factors for mortality.
Conclusion: NC-HCC patients were diagnosed more often outside a screening programme. The patients
were older, with a higher female prevalence and despite an advanced stage, were often amenable to surgery.