Hepatocellular carcinoma in patients without cirrhosis: relevance and clinical characteristics

Abstract

Aim: The present study evaluated the frequency of hepatocellular carcinoma (HCC) in patients without cirrhosis.

Methods: HCC patients were recruited from two reference centers for liver disease in Northeast Brazil from 2010 to 2016. The diagnosis of HCC and cirrhosis was based on international criteria.

Results: A total of 169 patients were included, and 16% (27) of the patients did not have hepatocellular carcinoma in non-cirrhosis (HCC-NC). The mean age of HCC-NC was 64.4 ± 11.3 years, and 74.1% of the patients were male. The main risk factors were hepatitis C virus (HCV) in 29.6% (8), nonalcoholic steatohepatitis (NASH) in 14.8% (4) and hepatitis B virus (HBV) in 11.1% (3). Histological HCC diagnosis was performed in 81.5% (22) of the patients, and in 18.5% (5) of these patients, the diagnosis was performed by ultrasonography, computed tomography or nuclear magnetic resonance imaging methods. Single nodules were found in 56% of HCC-NC (14) when assessed by imaging methods.

Conclusion: The frequency of HCC-NC was elevated and more common in males. HCV, NASH and HBV were the most frequent risk factors. These data contribute to discussion on future protocols and criteria for the early diagnosis and treatment of HCC in patients with chronic liver disease without cirrhosis.

Keywords

Hepatocellular carcinoma / primary liver tumor / liver cirrhosis

References

[1] Ferlay J,Ervik M,Eser S,Rebelo M,Forman D.Cancer incidence and mortality worldwide: source, method and major patterns in GLOBOCAN 2012..Int J Cancer2015;136:E359-86

[2] Paranaguá-Vezozzo DC,Alvarado-Mora MV,Cunha-Silva M,Alves VA,Carrilho FJ.Epidemiology of HCC in Brazil: incidence and risk factors in a ten-year cohort..Ann Hepatol2014;13:386-93

[3] Carrilho FJ,Branco F,Mattos AA.Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil..Clinics2010;65:1285-90 PMCID:PMC3020338

[4] Fattovich G,Zagni I.Hepatocellular carcinoma in cirrhosis: incidence and risk factors..Gastroenterology2004;127:S35-50

[5] Trevisani F,Santi V,Bernardi M.Hepatocellular carcinoma in non-cirrhotic liver: a reappraisal..Dig Liver Dis2010;42:341-7

[6] El-Serag HB.Hepatocellular carcinoma..N Engl J Med2011;365:1118-27

[7] Wörns MA,Victor A,Hoppe-Lotichius M,Hansen T,Niederle IM,Weinmann A,Galle PR.Prognostic factors and outcomes of patients with hepatocellular carcinoma in non-cirrhotic liver..Scand J Gastroenterol2012;47:718-28

[8] Schütte K,Kahl S,Götze T,Arend J,Lippert H,Malfertheiner P.Clinical characteristics and time trends in etiology of hepatocellular cancer in Germany..Digestion2013;87:147-59in German

[9] Fattovich G,Donato F.Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors..J Hepatol2008;48:335-52

[10] Bonilla Guerrero R.The role of hepatitis B virus integrations in the pathogenesis of human hepatocellular carcinoma..J Hepatol2005;42:5760-77

[11] Albeldawi M,Lopez R.Hepatitis C virus associated primary hepatocellular carcinoma in non-cirrhotic patients..Dig Dis Sci2012;57:3265-70

[12] Younossi ZM,Afendy M,Younossi Y.Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008..Clin Gastroenterol Hepatol2011;9:524-30

[13] Welzel TM,Zeuzem S,Davila JA.Metabolic syndrome increases the risk of primary liver cancer in the United States: a study in the SEER-Medicare database..Hepatology2011;54:463-71 PMCID:PMC4141525

[14] EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma..J Hepatol2012;56:908-43

[15] International Consensus Group for Hepatocellular Neoplasia..Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia..Hepatology2009;49:658-64

[16] Llovet JM,Bruix J.Hepatocellularcarcinoma..Lancet2003;362:1907-17

[17] Pereira LM,Moreira RC,Stein AT,Figueiredo GM,Braga C,Coral G,Lima ML,Costa M,Ximenes RA.Prevalence and risk factors of hepatitis C infectious in Brazil. 2005 through 2009: a cross-sectonal study..BMC Infect Dis2013;13:60 PMCID:PMC3574834

[18] Farazi PA.Hepatocellular carcinoma pathogenesis: from genes to environment..Nat Rev Cancer2006;6:674-87

[19] Adams LA,Sauver J,Lindor KD,Angulo P.The natural history of nonalcoholic fatty liver disease: a population-based cohort study..Gastroenterology2005;129:113-21

[20] Ekstedt M,Mathiesen UL,Holmqvist M,Kechagias S.Long-term follow-up of patients with NAFLD and elevated liver enzymes..Hepatology2006;44:865-73

[21] Dam-Larsen S,Andersen IB,Jensen LB,Becker U.Long term prognosis of fatty liver: risk of chronic liver disease and death..Gut2004;53:750-5 PMCID:PMC1774026

[22] Rosmorduc O.HCC and NASH: how strong is the clinical demonstration?.Clin Res Hepatol Gastroenterol2012;36:202-8

[23] Cotrim HP,Coelho HS,Nabuco L,Ivantes C,Galizzi-Fiho J.Members of the Brazilian society of hepatology HCC..Clinics (Sao Paulo).2016;71:281-4

[24] Alkofer B,Chiche L.Hepatocellular cancer in the non-cirrhotic liver..J Visc Surg2011;148:3-11

[25] Sarpel U,Lobach I,Newman E.Inverse relationship between cirrhosis and massive tumours in hepatocellular carcinoma..HPB (Oxford).2012;14:741-5 PMCID:PMC3482669