Clinical Features and Outcome of Hepatocellular Carcinoma Patients Without Etiologic Risk Factors

Abstract

Background: The etiologic risk factors for the development of hepatocellular carcinoma (HCC) are viral predisposing conditions (hepatitis B and C virus, HBV/ HCV), non-viral cirrhosis-related factors (diabetes mellitus, DM; non-alcoholic fatty liver; obesity) and environmental factors (alcohol consumption).We examined the characteristics and outcomes of HCC patients with or without these risk factors. Methods: Patients pathologically diagnosed as having HCC between 2002 and 2009 were selected for risk factors based on their clinical characteristics.We classified the patients etiologically into three groups: patients without risk factors (group I), patients with HBV/HCV infection (group II), and patients with alcohol consumption, DM, and/or obesity (group III). The clinical factors of each group were evaluated using the Fisher exact test and theWilcoxon rank sum test. Furthermore, overall survival (OS) and recurrence-free survival (RFS) were estimated for patients who had undergone a hepatectomy as the first treatment, and the patients in group I were compared with those in groups II and III using the Kaplan-Meier method. Results: Of the 159 patients screened, 16 (10%) were included in group I, 105 (66%) in group II, and 38 (24%) in group III. No significant differences in the Child-Pugh score were observed among the groups. Compared with group II, the patients in group I were significantly older (P < 0.01) and were more likely to be men (P < 0.01). They also had fewer tumors (P < 0.05), a larger tumor diameter (P < 0.01), fewer intrahepatic metastases (P < 0.05) and a lower disease stage (P = 0.04) than group II. Compared with group III, the patients in group I had significantly fewer tumors (P = 0.02). The level of PIVKA-II was higher in group I than in groups II and III (P < 0.01 and P < 0.03, respectively). Of the 121 patients who received a hepatectomy as their first treatment, the OS period for group I was not significantly longer than those for the other groups. The RFS period was significantly longer for group I than for group II (P < 0.01). Conclusion: The clinical features of HCC patients without risk factors were presented. The results suggest that the clinical features of HCC are associated with etiologic risk factors. To define the biological bias, further investigation, using paraffin-embedded tissues, is needed.