title: A comparison of surgical outcomes for noncirrhotic and cirrhotic hepatocellular carcinoma patients in a Western institution.
abstract: BACKGROUND
  Although cirrhosis is common among Western hepatocellular carcinoma (HCC) patients, a substantial proportion are not cirrhotic. Studies examining surgical outcomes in noncirrhotic patients primarily evaluate Asian populations and liver resections. We describe cirrhotic and noncirrhotic HCC patients undergoing resection and transplantation at a Western institution.
  
  
  METHODS
  We retrospectively reviewed 188 HCC patients treated surgically from 2000 to 2011 at a single Western institution. The primary endpoint was recurrence. Secondary endpoints included time to recurrence and overall survival.
  
  
  RESULTS
  We evaluated 138 cirrhotic and 50 noncirrhotic patients with a median follow-up of 33.8 months. Noncirrhotics mostly underwent liver resection (90%), whereas cirrhotics primarily underwent transplantation (67%). Hepatitis B was the most common underlying liver disease for noncirrhotics (64%), whereas hepatitis C (55%) and alcohol abuse (32%) predominated among cirrhotics. Pathologic evaluation demonstrated tumors in noncirrhotics that were fewer in number, larger, less differentiated, and more likely to have vascular invasion. Recurrence was more common for noncirrhotics (36 vs. 18%; P = .008) and more common after resection compared with transplantation. Overall median survival was 46.9 months for both groups. After resection, noncirrhotics had longer survival times than did cirrhotics (41.6 vs. 32.9 months; P = .04). Vascular invasion was an independent predictor for recurrence; tumor size was a predictor of mortality.
  
  
  CONCLUSIONS
  Noncirrhotics in our Western cohort had higher risk pathologic features, more frequently underwent resection, and suffered more recurrences than did cirrhotics. Overall survival was similar for both groups. Prospective studies of noncirrhotic HCC patients in Asia and Western countries may inform surveillance and treatment.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. rbeard@bidmc.harvard.edu
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Beard
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Miksad
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome