title: Clinical characteristics of NonBNonC- HCC: Comparison with HBV and HCV related HCC.
abstract: OBJECTIVE
  To clarify the frequency and trends of both HBsAg and HCVAb negative hepatocellular carcinoma (NonBNonC-HCC) in all HCC, to clarify the etiology of NonBNonC-HCC, and to elucidate the clinical characteristics of NonBNonC-HCC compared with those of HBsAg-positive HCC (B-HCC) and HCVAb-positive HCC (C-HCC).
  
  
  METHODS
  A total of 2,542 patients with HCC examined at three institutions between 1991 and 2004 were categorized based on their serum viral antigen/antibody positivities, and compared between groups for the etiology, annual trend of the incidence, and clinical characteristics.
  
  
  RESULTS
  For the etiology, C-HCC was most prevalent, followed by B-HCC, NonBNonC-HCC, and both HBsAg and HCVAb-positive HCC (BC-HCC) in order. For survival, C-HCC had the most favorable prognosis, followed by NonBNonC-HCC, and B-HCC patients had the poorest prognosis in the three groups (C-HCC, B-HCC, and NonBNonC-HCC). In tumor-node metastasis (TNM) stages I+II, however, NonBNonC-HCC patients took the most favorable clinical course. The incidence of NonBNonC-HCC in all HCC was 5-8% from 1991 to 1998, and has increased to 10-12% since 1999. Additionally, the incidence of HBcAb-positive HCC in NonBNonC-HCC declined each year. Among NonBNonC-HCC patients, the morbidity of diabetic complications was significantly higher in HBcAb-negative patients than in HBcAb-positive patients.
  
  
  CONCLUSIONS
  Although the incidence of NonBNonC-HCC among all HCC has an increasing trend recently, the incidence of HBcAb-positive HCC in NonBNonC-HCC has a tendency of decreasing. This fact suggest its etiology might be changing from occult HBV related HCC to unknown etiology such as nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) related HCC. The prognosis of NonBNonC-HCC was fairly good if the HCC was found in its early stage.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Kinuyo
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Toyokazu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Ueshima
authors.forename: Hobyung
authors.initials: H
authors.lastname: Chung
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Minami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Akio
authors.initials: A
authors.lastname: Orino
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies