Characterization and prognosis of patients with hepatocellular carcinoma (HCC) in the non-cirrhotic liver

Schütte, Kerstin; Schulz, Christian; Poranzke, Janine; Antweiler, Kai; Bornschein, Jan; Bretschneider, T.; Arend, Jörg; Ricke, Jens; Malfertheiner, Peter

doi:10.1186/1471-230x-14-117

Cited by 115 publications

(126 citation statements)

References 33 publications

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“…In the current work, we observed an overall low mean age of patients (46 years) when compared to the situation prevailing in resource-rich countries where the tumor mostly occurs at an age that ranges from the late fifties to the early seventies (approximate mean age 65 years) [21–25] . Our data are, however, similar to that reported in previous studies conducted on Cameroonian HCC cases and to other studies conducted in Central Africa countries like Gabon [26].…”

Section: Discussionmentioning

confidence: 99%

A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa

et al. 2016

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BackgroundHepatocellular Carcinoma (HCC) is one of the commonest cancers in Central Africa, a region with the unusual peculiarity to be hyperendemic for infections with Hepatitis B, C and D viruses. However, data estimating the respective proportions of HCC cases attributable to these viruses are still limited in this area. The current study was undertaken to determine the role of these viruses in HCC compared to non-HCC Cameroonian patients.MethodsA case–control study was conducted in the Gastroenterology Unit of Central Hospital of Yaounde in collaboration with Centre Pasteur of Cameroon. Blood samples of all HCC cases (n = 88) and matched control individuals without known liver disease (n = 85) were tested for serological markers of Hepatitis B, C and D viral infections using commercially available enzyme immune-assay kits. Hepatitis B and C viral loads were quantified for positive patients by real-time PCR using commercial kits.ResultsThe mean age was 46.0 ± 18 and 42.1 ± 16 years old for HCC-patients and controls, respectively for a 2.3 Male/Female sex ratio. The prevalence of hepatitis B surface antigen, antibody to HCV and antibody to HDV were significantly higher in HCC patients (65.90, 20.26 and 26 % respectively) than in control patients (9.23, 4.62 and 1 %) (P < 2.5 10−5). The risk factors analysis showed that both HBV and HCV infections were strongly associated with HCC development in Cameroon with crude odds ratios of 15.98 (95 % CI 6.19-41.25) and 7.33 (95 % CI 2.09-25.77), respectively. Furthermore, the risk of developing HCC increased even more significantly in case of HBV and HDV co-infections with the odd ratio of 29.3 (95 % CI, 4.1-1231). HBV-DNA level was significantly higher in HBsAg-positive HCC-patients than in HBsAg-positive controls with (6.3 Log IU/mL and 5.7 Log IU/mL) respectively (P < 0.05).ConclusionHBV and HCV infections are the mains factors of HCC development in Cameroon. Our results show that patients co-infected with HDV are at very high risk to develop HCC. An active surveillance program of patients and, foremost, an easier access to antivirals and primary prevention measures are crucial steps to reduce the incidence of HCC in this country. Due to the lack of truly efficient antiviral therapy, the fate of HDV-infected patients remains, however, particularly worrying.

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Section: Discussionmentioning

confidence: 99%

A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa

et al. 2016

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“…Given the high number of patients with non cirrhotic NAFLD, screening for HCC in this population is not practicable [15] . Interestingly, the features of NAFLD-related HCC are similar to those of HCC of obese patients and of non-cirrhotic HCC, independently of the etiology [92,93] . Accordingly, it has been reported that obese patients have a relative risk of liver cancer of 189% relative to the 117% of overweight subjects [94] .…”

Section: Hcc In Nafld Chronic Hepatitismentioning

confidence: 84%

Fat and hepatocellular carcinoma

Balsano¹,

Porcu²,

Sideri³

et al. 2018

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Obesity and diabetes are associated with the onset of hepatocellular carcinoma (HCC). These two illnesses correlate also with the development of non-alcoholic fatty liver disease (NAFLD). Currently, NAFL is considered the leading form of chronic liver disease in the Western industrialized countries. Insulin resistance is the common pathogenic factor among these three pathologies. NAFL is characterized by fat accumulation in the liver that involves greater than 5% of the liver parenchyma with no evidence of hepatocyte injury. However, NAFL may progress toward non-alcoholic steatohepatitis that in turn may lead to advanced fibrosis, cirrhosis and HCC. It is alarming that NAFLD related HCC has been, at present, considered as a growing burden worldwide, and its prevalence is tending to further increase together with the increasing incidence of obesity and diabetes. Worthy of note is that in the presence of chronic accumulation of fat in the liver it has been reported the emergence of HCC during chronic liver disease in absence of liver cirrhosis, usually the major risk factor for the development of HCC. Thus, in the future NAFLD related HCCs will place a growing strain on health-care systems from the need for their management. Unfortunately, most of the NAFLD related HCC patients are diagnosed at advanced stages and are characterized by a poor prognosis, because they are ineligible to radical treatments. Thus, it is urgent to boost up new screening policies to make early diagnoses, as well as to develop preventive-therapeutic strategies.

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“…In patients without liver disease, HCC tends to be diagnosed at a more advanced age than in patients with cirrhosis and it is usually detected in latter stages (BCLC D in 51.6% vs 42% in patients with cirrhosis) due to the lack of screening; however, mortality in patients in intermediate stages is lower than that in patients with cirrhosis. In this group of patients, the BCLC classification correlates best with survival than other staging systems and their survival rates are better due to the possibility of providing curative treatment of larger lesions in turn, leading to decreased recurrences (27% vs 73%) and greater survival (81% vs 23%) [116,117] . Upon recent inclusion of molecular markers such as wtER, IGF and VEGF-1 in prognostic scoring systems such as CLIP, their precision has been favorable although they are not currently routinely used [118][119][120] .…”

Section: Prognosismentioning

confidence: 95%

Diagnosis and treatment of hepatocellular carcinoma: An update

Tejeda-Maldonado¹

2015

WJH

107

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Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium "washout" in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and locoregional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion's stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. Core tip: This paper reviews the most recent evidence on hepatocarcinoma including its molecular pathogenesis and prognosis, with special emphasis on its diagnosis, staging and treatment. The most recent Easter and Western international guidelines are also reviewed.

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Characterization and prognosis of patients with hepatocellular carcinoma (HCC) in the non-cirrhotic liver

Cited by 115 publications

References 33 publications

A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa

A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa

Fat and hepatocellular carcinoma

Diagnosis and treatment of hepatocellular carcinoma: An update

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