J Liver Cancer.  2021 Mar;21(1):34-44. 10.17998/jlc.21.1.34.

Incidence and Clinical Features of Hepatitis C Virus-associated Hepatocellular Carcinoma Patients without Liver Cirrhosis in Hepatitis B Virus-endemic Area

• Shin J
• Yu JH
• Jin YJ
• Lee JW

• KMID: 2514233
• DOI: http://doi.org/10.17998/jlc.21.1.34

Abstract

Background
/objective: Hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) is rarely observed in patients without liver cirrhosis (LC). We evaluated the incidence and clinical feature of HCV-associated HCC patients with or without LC.
Methods
The medical records of 1,516 patients diagnosed as having primary HCC at our hospital between January 2005 and December 2017 were retrospectively reviewed. Of these, 154 (10.2%) HCV-associated HCC patients were analyzed. LC was diagnosed histologically or clinically.
Results
Seventeen (11.0%) of the 154 patients had non-cirrhotic HCC, and all were of Child-Turcotte-Pugh (CTP) class A, Among the 17 patients, 88.2% were male, all had nodular type HCC, and only 2 (11.8%) were under HCC surveillance. Median overall survival (OS) of HCV-associated HCC patients with and without LC was 15 months and 37 months, respectively. Cumulative OS rates were not different between non-cirrhotic patients and cirrhotic patients with CTP class A (P=0.229). Cumulative OS rates were significantly higher in non-cirrhotic patients than in cirrhotic patients of CTP class B (P<0.001) or C (P<0.001). Multivariate analyses showed serum AST (hazard ratio [HR] 1.01, P=0.003) and AFP levels (HR 1.01, P=0.016), antiviral therapy (HR 0.25, P=0.022), and LC of CTP class B (HR, 5.24, P=0.006) or C (HR 21.79, P<0.001) were significantly associated with prognosis in HCV-associated HCC patients.
Conclusions
HCC in a non-cirrhotic liver was found in 11% of HCV-associated HCC patients. OSs of HCV-associated HCC patients were better in those of CTP A, regardless of LC than in those with LC of CTP class B or C.

Keyword

Hepatocellular carcinoma; Hepatitis C virus; Cirrhosis; Non-cirrhosis

Figure

• 

  Figure 1 Study population. One hundred and fifty-four hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) patients were enrolled in this study. CCC, cholangiocarcinoma; HBV, hepatitis B virus; NAFLD, non-alcoholic fatty liver disease; PBC, primary biliary cirrhosis.

• 

  Figure 2 Relations between cumulative overall survival and the presence of liver cirrhosis. Cumulative overall survivals of hepatitis C virus-associated hepatocellular carcinoma patients without liver cirrhosis (LC) were significantly better than those of patients with LC (P = 0.036). OS, overall survival; FU, follow-up.

• 

  Figure 3 Relations between cumulative overall survivals and Child-Turcotte-Pugh (CTP) class in hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) patients with or without liver cirrhosis. Cumulative overall survival (OS)s were not significantly different between non-cirrhotic and cirrhotic CTP class A patients (P = 0.229). However, OSs of HCV-associated HCC patients were better for those of CTP class A, regardless of liver cirrhosis (LC), than for patients with LC of CTP class B or C (P-values for all <0.001). Gr. A, CTP class A patients without LC; Gr. B, CTP class A patients with LC; Gr. C, CTP class B patients with LC; Gr. D, CTP class C patients with LC; FU, follow-up; Gr, group.

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