Impact of Hepatic Steatosis on Disease-Free Survival in Patients with Non-B Non-C Hepatocellular Carcinoma Undergoing Hepatic Resection.
BACKGROUND
Although the prevalence of non-B non-C hepatocellular carcinoma (NBNC HCC) has increased, its clinicopathologic characteristics remain unclear.


METHODS
We retrospectively analyzed 518 HCC patients who underwent hepatic resection. Hepatitis B surface antigen- and hepatitis C antibody-negative patients were categorized into the NBNC HCC group (n = 145); others were categorized into the hepatitis B or C HCC (BC HCC) group (n = 373). We subdivided the etiologies of NBNC HCC according to alcohol intake and presence of steatosis.


RESULTS
NBNC HCC was associated with nonalcoholic fatty liver disease (NAFLD) (13.1 %), fatty liver disease with moderate alcohol intake (9.0 %), alcoholic liver disease (ALD) (29.7 %), cryptogenic disease (44.1 %), and other known etiologies (4.1 %). The prevalence of obesity, diabetes mellitus, and hypertension was higher and hepatic function was better in the NBNC HCC group, which had significantly larger tumors than the BC HCC group. The entire NBNC HCC group displayed similar overall and disease-free survival as the BC HCC group. Among the subdivisions, NAFLD-associated HCC patients had significantly better disease-free survival than ALD-associated HCC and BC HCC patients. Microvascular invasion (hazard ratio [HR] 2.30; 95 % confidence interval [CI] 1.33-3.96) and steatosis area <5 % of noncancerous region (HR 2.13; 95 % CI 1.21-3.93) were associated with disease-free survival in NBNC HCC patients.


CONCLUSIONS
The prognosis of NBNC HCC was similar to that of BC HCC. Among NBNC HCC patients, NAFLD-associated HCC patients had a relatively low recurrence risk. Absence of steatosis in hepatic parenchyma had a significant impact on disease-free survival in NBNC HCC patients.
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Takahiro
T
Nishio
Etsuro
E
Hatano
Takaki
T
Sakurai
Kojiro
K
Taura
Masayuki
M
Okuno
Yosuke
Y
Kasai
Satoru
S
Seo
Kentaro
K
Yasuchika
Akira
A
Mori
Toshimi
T
Kaido
Shinji
S
Uemoto
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D005234:Fatty Liver / Q000150:complications* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies