title: Problems of Long Survival Following Surgery in Patients with NonBNonC-HCC: Comparison with HBV and HCV Related-HCC.
abstract: BACKGROUND
  The number of patients with hepatocellular carcinoma (HCC) in the absence of both hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCVAb) (NBNC-HCC) has been rapidly increasing in Japan. The objective of this study was to compare the clinical and pathological characteristics between patients with the NBNC-HCC, those with HBsAg positive HCC (B-related HCC) and HCVAb positive HCC (C-related HCC). A better understanding will facilitate the development of postoperative strategies to better manage patients with NBNC-HCC.
  
  
  METHODS
  Consecutive 219 patients with primary HCC: (B-related, n=35; C-related, n = 104; NBNC, n = 80) were treated by hepatic resection or ablation. Clinicopathological characteristics including postoperative course were retrospectively compared between the three groups.
  
  
  RESULTS
  When comparing within stage I and II, the NBNC-HCC group had improved recurrence free survival (RFS) compared to the C-related HCC (p = 0.013) but had not been good overall survival (OS). Moreover, the NBNC-HCC group showed higher rate of death due to other cancers and cardiovascular disease (p = 0.011) compared to the C-related HCC. Multivariate analysis revealed that the only prognostic factor for RFS in the NBNC-HCC group was high serum total bilirubin.
  
  
  CONCLUSIONS
  In the patients with the NBNC-HCC, elevated serum bilirubin could predict poor RFS after surgery. Furthermore, patients must be carefully followed-up not only for HCC but also for the occurrence of other critical diseases including multiple other cancers.
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Kiyokazu
authors: K
authors: Hiwatashi
authors: 2. Department of Clinical Oncology, Graduate School of Medical and Dental Sciences Kagoshima University.
authors: Shinichi
authors: S
authors: Ueno
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Masahiko
authors: M
authors: Sakoda
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Satoshi
authors: S
authors: Iino
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Koji
authors: K
authors: Minami
authors: 2. Department of Clinical Oncology, Graduate School of Medical and Dental Sciences Kagoshima University.
authors: Yoichi
authors: Y
authors: Yamasaki
authors: 2. Department of Clinical Oncology, Graduate School of Medical and Dental Sciences Kagoshima University.
authors: Keishi
authors: K
authors: Okubo
authors: 2. Department of Clinical Oncology, Graduate School of Medical and Dental Sciences Kagoshima University.
authors: Masahiro
authors: M
authors: Noda
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Hiroshi
authors: H
authors: Kurahara
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Yuko
authors: Y
authors: Mataki
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Kosei
authors: K
authors: Maemura
authors: 3. Faculty of Medical School of Health Sciences, Graduate School of Health Sciences Kagoshima University.
authors: Hiroyuki
authors: H
authors: Shinchi
authors: 1. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medical and Dental Sciences Kagoshima University, Sakuragaoka 8-35-1 Kagoshima, 890-8520, Japan.
authors: Shoji
authors: S
authors: Natsugoe
keywords: HBs antigen; HCV antibody; NBNC-HCC; hepatocellular carcinoma; surgical resection