Hepatocellular Carcinoma in Cirrhotic and Noncirrhotic Livers:A Clinico-Histopathologic Study of 804 North American Patients

Abstract

This study examined clinico-histopathologic differences between North American patients who developed hepatocellular carcinoma with and without cirrhosis.Histologic slides and clinical records of cases were reviewed. Cases were classified according to defined histopathologic criteria. Analyses were performed using appropriate tests.A total of 42.6% of cases were noncirrhotic. The trabecular type of hepatocellular carcinoma was the most common growth pattern in both groups. Patients with cirrhosis were significantly older, had high grade tumors, and local portal venous invasion significantly more often than patients without cirrhosis. Encapsulated tumors occurred in significantly more in patients without cirrhosis. Patients without cirrhosis survived longer than patients with cirrhosis {P -c.OOOl) and had a better 5-year survival experience. On average, in patients with cirrhosis, serum aspartate transaminase and total serum bilirubin were significantly greater, and serum albumin was significantly lower.In general, hepatocellular carcinoma in North American patients with cirrhosis tended to be less well differentiated than those found among patients without cirrhosis. The pathology, natural history, and prognosis of this tumor is significantly influenced by the presence or absence of cirrhosis in the nonneoplastic liver, and the presence of cirrhosis portends a poorer prognosis.

Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index

“…In a previous study, 11 HCC was identified in 19% of alcoholic liver disease patients without evident cirrhosis. In another study, 12 14% of alcoholics with HCC did not have cirrhosis.…”

Association of E-cadherin, matrix metalloproteinases, and tissue inhibitors of metalloproteinases with the progression and metastasis of hepatocellular carcinoma

“…[30][31][32] Survival advantages of hepatocellular carcinomas arising from noncirrhotic liver over hepatocellular carcinomas arising from cirrhotic liver have been well documented. [33][34][35] This survival difference is believed to be because of the poor liver functional reserve in cirrhotic liver and the tendency towards development of a new primary after surgery. 36,37 However, it is yet unknown whether there is any effect of cirrhosis on the metastatic potential of hepatocellular carcinomas.…”

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

“…[71][72][73] This figure is in line with the results of a few small UK series from the 1980s, in which rates of 73-80% were reported, [74][75][76] and comparable with data from elsewhere in Europe (71-88% in France, [77][78][79][80] 75-90% in Germany, [81][82][83][84][85] 77-97% in Italy [86][87][88][89][90][91][92] and 93% in Spain 93 ). The picture may be different in North America, where similar studies suggest that the proportion of HCC patients who have cirrhosis is as low as 58% 94 to 63%. 95 The rate at which cirrhotic livers progress to HCC is one of the key topics under review in the present study, and is addressed in detail below.…”