title: Characteristics and prognosis of patients in Japan with viral marker-negative hepatocellular carcinoma.
abstract: OBJECTIVE
  The characteristics and prognosis of patients with hepatitis virus marker-negative hepatocellular carcinoma (HCC) is not fully elucidated in Japan. We investigated the characteristics and prognosis of HCC patients in whom no markers for hepatitis virus infection were detected, in comparison with those of HCC patients with hepatitis virus infection.
  
  
  METHODS
  Viral markers for hepatitis B and C virus (HBV and HCV) infection were measured in 1152 patients in whom initial HCC was diagnosed between 1991 and 2004. Patient characteristics, characteristics of HCC and survival were compared between patients in whom no marker was positive (viral marker-negative HCC) and those in whom chronic HBV or HCV infection was confirmed by viral markers (viral HCC).
  
  
  RESULTS
  Overall, 119 patients (10.3%) were shown to have viral marker-negative HCC. Hepatocellular carcinoma was detected under surveillance in a significantly smaller percentage of patients with viral marker-negative HCC than of patients with viral HCC (P < 0.0001). The tumor was significantly larger (P < 0.0001) and vascular invasion was significantly more prevalent (P = 0.0003) in patients with viral marker-negative HCC than in those with viral HCC. The survival rate of patients with viral marker-negative HCC was significantly lower than that of patients with viral HCC (P = 0.0378).
  
  
  CONCLUSIONS
  The patients with HCC in whom hepatitis viral infection had not been confirmed tended not to be under surveillance, resulting in the detection of HCC at more advanced stage and with a poorer prognosis. Efforts to identify patients without hepatitis virus infection who should be under surveillance for HCC will be necessary in the future.
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.forename: Seiki
authors.initials: S
authors.lastname: Kiriyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sone
authors.forename: Makoto
authors.initials: M
authors.lastname: Tanikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hisanaga
authors.forename: Akira
authors.initials: A
authors.lastname: Kanamori
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Isogai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneoka
authors.forename: Junji
authors.initials: J
authors.lastname: Washizu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000821:virology*; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral