J Cancer 2015; 6(5):438-447. doi:10.7150/jca.10398

Research Paper

Problems of Long Survival Following Surgery in Patients with NonBNonC-HCC: Comparison with HBV and HCV Related-HCC

Kiyokazu Hiwatashi1✉, Shinichi Ueno2, Masahiko Sakoda1, Satoshi Iino1, Koji Minami1, Yoichi Yamasaki2, Keishi Okubo2, Masahiro Noda2, Hiroshi Kurahara1, Yuko Mataki1, Kosei Maemura1, Hiroyuki Shinchi3, Shoji Natsugoe1

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
2. Department of Clinical Oncology, Graduate School of Medical and Dental Sciences Kagoshima University
3. Faculty of Medical School of Health Sciences, Graduate School of Health Sciences Kagoshima University

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Hiwatashi K, Ueno S, Sakoda M, Iino S, Minami K, Yamasaki Y, Okubo K, Noda M, Kurahara H, Mataki Y, Maemura K, Shinchi H, Natsugoe S. Problems of Long Survival Following Surgery in Patients with NonBNonC-HCC: Comparison with HBV and HCV Related-HCC. J Cancer 2015; 6(5):438-447. doi:10.7150/jca.10398. Available from http://www.jcancer.org/v06p0438.htm

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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.

Keywords: hepatocellular carcinoma, NBNC-HCC, surgical resection, HBs antigen, HCV antibody