title: Hepatocellular carcinoma within a noncirrhotic, nonfibrotic, seronegative liver: surgical approaches and outcomes.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) most commonly arises in patients with chronic liver disease. Data on outcomes after liver resection in patients with noncirrhotic, nonfibrotic, seronegative, referred to as a "normal" liver are limited. We aimed to investigate differences in prognostic factors and outcomes between patients presenting with HCC arising in "normal" liver (NLHCC) and that arising in "diseased" liver (DLHCC).
  
  
  METHODS
  All patients undergoing resection for HCC between 1994 and 2008 were assessed. Multivariable analysis of clincopathologic data from the NLHCC group was performed by comparing them with data from the group who had surgery for DLHCC during this period.
  
  
  RESULTS
  During the 15-year study period, 142 patients underwent liver resection for HCC: 81 for NLHCC and 61 for DLHCC. NLHCCs were more often solitary but were larger and required more major resections. There was no significant difference in survival outcomes between patients who had NLHCC or DLHCC, with overall and recurrence-free 5-year survivals of 60% and 51% in NLHCC and 55% and 33% in DLHCC, respectively. In patients with NLHCC, significant factors predicting overall survival were blood transfusion requirement (p = 0.003) and age (p = 0.009), and the only significant factor at predicting recurrence-free survival was presence of multiple tumors (p = 0.025). In contrast, in DLHCC, the only significant prognostic variables were a preoperative tumor biopsy (p = 0.017) or a high neutrophil-to-lymphocyte ratio (p = 0.001), both of which predicted a poorer recurrence-free survival.
  
  
  CONCLUSIONS
  HCC presenting in patients with a normal background liver parenchyma appears to present a different spectrum of the disease. However, excellent outcomes can be achieved after liver resection, although this often requires the use of advanced techniques due to late presentation.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, United Kingdom.
authors.forename: Alastair L
authors.initials: AL
authors.lastname: Young
authors.forename: Robert
authors.initials: R
authors.lastname: Adair
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016019:Survival Analysis; D055815:Young Adult