Pompilia Radu,Guillaume  Aeby,Birgit  Schwacha-Eipper,Philippe  Kolly,Codruta  Mare,Vanessa  Banz,JeanFrançois  Dufour,
Hepatocellular Carcinoma in Cirrhotic Versus Non-Cirrhotic Patients: A Retrospective Study of 483 Patients
Journal of Surgical Oncology
2020
2674-3000
http://dx.doi.org/10.31487/j.JSO.2020.06.07
https://www.sciencerepository.org/hepatocellular-carcinoma-in-cirrhotic-versus-non-cirrhotic-patients_JSO-2020-6-107 
Abstract: 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.Keywords:  Hepatocellular carcinoma, non-cirrhotic hepatocellular carcinoma, cirrhotic hepatocellular carcinoma, non-alcoholic fatty liver disease, surveillance, survival