title: Clinical characteristics, treatment, and prognosis of non-B, non-C hepatocellular carcinoma: a large retrospective multicenter cohort study.
abstract: BACKGROUND
  The number of hepatocellular carcinoma (HCC) patients with non-viral etiologies is increasing in Japan. We conducted a nation-wide survey to examine the characteristics of those patients.
  
  
  METHODS
  After we assessed the trend of patients who were first diagnosed with HCC at 53 tertiary care centers in Japan from 1991 to 2010, we collected detailed data of 5326 patients with non-viral etiology. The etiologies were categorized as autoimmune hepatitis, primary biliary cirrhosis, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), unclassified, and other. Baseline characteristics at initial diagnosis, the modality of the initial treatment, and survival status were collected via a website. Survival of the patients was assessed by the Kaplan-Meier method and Cox proportional hazard regression.
  
  
  RESULTS
  The proportion of patients with non-viral etiologies increased from 10.0% in 1991 to 24.1% in 2010. Of the patients, 92% were categorized as ALD, NAFLD, or unclassified. Body mass index (BMI) was ≥ 25 kg/m(2) in 39%. Diabetes was most prevalent in NAFLD (63%), followed by unclassified etiology (46%) and ALD (45%). Approximately 80% of patients underwent radical therapy, including resection, ablation, or transarterial chemoembolization. Survival rates at 3, 5, 10, 15, and 20 years were 58.2, 42.6, 21.5, 15.2, and 15.2%, respectively. Multivariate analysis revealed that patients with BMI > 22 and ≤ 25 kg/m(2) showed the best prognosis versus other BMI categories, after adjusting by age, gender, tumor-related factors, and Child-Pugh score.
  
  
  CONCLUSIONS
  Most cases of non-B, non-C HCC are related to lifestyle factors, including obesity and diabetes. Slightly overweight patients showed the best prognosis.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, tateishi-tky@umin.ac.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
authors.forename: Naoto
authors.initials: N
authors.lastname: Fujiwara
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Okita
authors.forename: Kendo
authors.initials: K
authors.lastname: Kiyosawa
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada
authors.forename: Norio
authors.initials: N
authors.lastname: Hayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000453:epidemiology; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis