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.
Conclusion
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.
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Article info
Publication history
Published online: June 17, 2013
Accepted:
February 22,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
