Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area

Abstract

Objectives: Chronic hepatitis B virus (HBV) infection is the most common cause of hepatocellular carcinoma (HCC) in South Korea, but a high prevalence of metabolic diseases may result in increases in the incidence of cryptogenic HCC (cHCC). We studied characteristics of the cHCC in a single-center cohort. Methods: A cohort of 1,784 HCC patients newly diagnosed and treated at the National Cancer Center, Korea, between 2004 and 2009 was reviewed and analyzed. Results: The cause of HCC was categorized as cHCC, HBV, hepatitis C virus (HCV), or alcohol. Overall, 162 (9.1%) patients of the HCC cohort had cHCC, and their mean age was 61.9 years. The median survival of cHCC patients was 24.7 months, which was the second shortest among the four groups after HBV HCC. cHCC patients had the largest tumor size (mean 7.4 cm) and the second highest proportion of poor prognostic factors such as the proportion of poorly defined tumors and extrahepatic spread in imaging studies. cHCC patients had better survival than HBV HCC patients according to multivariate analysis. Among cHCC patients, 137 (84.6%) had anti-HBc IgG antibodies, but this sub-group had different clinical features to those of HBV HCC patients. The body mass index (BMI) and hyperglycemia and hypercholesterolemia levels in cHCC patients were similar to those in HCV and alcoholic HCC patients. Conclusions: Anti-HBc IgG antibodies were present in most cHCC patients, but cHCC patients had better survival than HBV HCC patients on multivariate analysis. However, cHCC patients had a larger mean tumor size and more aggressive tumor characteristics than HCV HCC or alcoholic HCC patients did. It is hoped that this study will contribute to a better understanding of cHCC in HBV-endemic areas.

Potential etiology, prevalence of cirrhosis, and mode of detection among patients with non-B non-C hepatocellular carcinoma in Korea

“…In this study, we analyzed a total of 447 consecutive NBNC HCC patients (13.4%) among 3,347 HCC patients registered in our institution. The proportion of NBNC HCC patients was slightly lower than the proportion reported from other hospitals in Korea, which ranged from 16.1% to 20.2% [5,17], and was also lower than that indicated by the nationwide cohort study in Korea, which reported an NBNC HCC prevalence of 27.4% [3]. In our cohort, the most common potential etiology of NBNC HCC was heavy alcohol use (n = 267, 59.7%).…”

“…Adam et al [28] reported that hepatocarcinogenesis in a non-cirrhotic liver was associated with a reduced number of clonal hepatocellular patches, analogous to aging-related changes, which may explain the older age at diagnosis in the absence of cirrhosis in many NBNC-NA-NO patients. Another study from Korea also reported that patients with cryptogenic HCC were much older than those with HCC associated with other etiologies [17]. However, the outcome of NBNC-NA-NO HCC was similar to NBNC-A HCC, despite several differences in baseline characteristics.…”

“…Another cohort study from Korea also reported the absence of cirrhosis in 27.5% of NBNC HCC patients [5], with a cirrhosis rate comparable to that of our study. Several studies have reported that fibrosis and cirrhosis are not always necessary for the development of HCC, especially for NAFLD-related HCC [17,18,25,26]. Kim et al [27] compared histologic findings between HBV-related HCC and NBNC HCC using data of surgically resected HCC patients in Korea and reported that most HBV-related HCC patients had septal fibrosis (85.6%, 297/360 patients) but were non-cirrhotic, while more than half (52.7%, 49/103 patients) of non-cirrhotic NBNC HCC patients had no fibrosis.…”

Clinicopathological Study of Autoimmune Hepatitis Cases That Were Difficult to Differentiate from Drug-Induced Liver Injury

“…Failure to properly treat AIH and DILI could result in clinically devastating acute or chronic outcomes [5,6] . Chronic AIH could also lead to hepatocarcinogenesis in the future [9][10][11] .…”

Long-Term Prognostic Factors after Hepatic Resection for Hepatitis C Virus-Related Hepatocellular Carcinoma, with a Special Reference to Viral Status

“…However, among the 14 studies entered into the systematic review, the era of the cohorts, observation periods, the proportion of patients with hepatitis viral infection (hepatitis B virus infection, HCV infection, and non-B non-C hepatitis), and the proportion of patients with liver cirrhosis were heterogeneous. It is well known that the recurrence pattern and survival after curative treatments differ according to underlying hepatic diseases such as the viral infection status [10][11][12][13]. However, the aforementioned 14 studies did not evaluate the effects of antiviral therapies even though controlling viral infections with antiviral therapies decreases postoperative HCC recurrence after hepatic resection [14,15].…”