Characteristics of Hepatocellular Carcinoma in Patients with Negative Virus Markers: Clinicopathologic Study of Resected Tumors

Abstract

Fifty-one cases of resected hepatocellular carcinoma (HCC) were retrospectively analyzed to evaluate the clinicopathologic features of HCC in patients with negative virus markers. The data were compared between three groups: hepatitis B surface antigen positive (HB, n = 11), hepatitis C virus antibody positive (HC, n = 21), and non-BC (both HbsAg and HCVAb negative, n = 12). Seven patients were excluded from the study because of operative death (n = 3), a history of alcohol abuse (n = 3), or the presence of dual positive HB and HC virus markers (n = 1). The data were analyzed by either an analysis of variance (ANOVA) or a contingency table. The age of the non-BC patients was higher (63.0 +/- 4.1, +/- SE) than that of HB patients (54.0 +/- 3.2, p < 0.05) but was identical to that of the HC group (62.0 +/- 1.8). Among the preoperative laboratory data, the serum glutamic oxaloacetate and glutamate pyruvate transaminoses (GOT, GPT) levels were statistically lower in the non-BC patients (32.8 +/- 4.8 and 28.0 +/- 4.4 IU/L, respectively) than in the HB and HC patients. The pathologic features of the resected specimens in the non-BC patients showed more invasive growth than in specimens from the HB or HC patients. The clinical stages (defined based on the criteria of the Japanese Association of Hepatocellular Carcinoma) were also more advanced in the non-BC patients than in the other groups. Postoperative survival time showed no significant difference among the groups. In conclusion, the non-BC patients had comparatively greater invasive growth and more advanced clinical stages than the HB and HC patients, despite the absence of liver cirrhosis, and so demonstrated the same poor survival data as observed in the HB and HC patients.

Clinical Characteristics of NonBNonC- HCC: Comparison with HBV and HCV Related HCC

“…At the time of initial onset, 59.8% of NonBNonC-HCC patients were at stages III + IV, while 52.6% of B-HCC and 41.8% of C-HCC patients were at stages III and IV. This results were consistent with the previous reports; the patients with NonBNonC-HCC tend to be detected in an advanced condition [23][24][25] . The poorer prognosis of NonBNonC-HCC may be attributable to its late detection in an advanced condition due to the lack of risk factors in many of NonBNonC-HCC patients.…”

Preoperative Predictors of Survival After Resection of Small Hepatocellular Carcinomas

“…Our finding that the long-term prognosis after resection of small HCC is influenced by factors relating to tumor and liver disease stage rather than hepatitis serology is consistent with the findings of other investigations on prognosis after resection of HCC regardless of size. 41,43,44,46 These data also suggest that serologic evidence of hepatitis B or C infection should not be used to exclude patients from consideration for resection.…”

Clinicopathological features of hepatocellular carcinomas (HCCs) arising in patients without chronic viral infection or alcohol abuse: a retrospective study of patients undergoing hepatic resection

“…4,5 In contrast to these conventional HCCs associated with virus infection, HCCs also develop in NBNC patients with good liver function reserve and are rarely complicated with chronic active inflammation. [8][9][10][11][12][13][14][15] The HCCs in NBNC patients represent a substantial proportion, comprising approximately 5% to 15% of the HCC population, [8][9][10][11][12][13][14][15] and their pathogenesis may be unique, because they seem to occur based on a pathogenesis other than liver inflammation or fibrosis. Several factors predisposing to hepatocarcinogenesis are known, including chemical agents, 29,30 latent HBV or HGV infection, [15][16][17][18] and carcinogenetic backgrounds.…”

“…[6][7][8] Along with the majority of HCCs associated with viral infection, there is a substantial population (5%-15%) of HCC patients who are negative for virus markers for HBV and HCV (NBNC patients) in Japan and Taiwan. [8][9][10][11][12][13][14][15] Although several studies have reported the clinicopathological features of these HCCs in comparison with viral-related HCCs, there are controversies about the liver function of the patients, the biological action of the tumors, and the patients' outcomes. [8][9][10][11][12][13][14][15] Some of the reasons for the differencies in study results are due to patient selection, including those with alcohol abuse, 13,14 the presence of autoimmune hepatic disBackground.…”