Hepatocellular carcinoma in the noncirrhotic liver: Clinical features and outcomes in Veracruz, Mexico

Abstract

Introduction and aim: Hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver. HCC in the noncirrhotic liver accounts for 15-20% of all HCC. Noncirrhotic HCC is a clinically different entity because of the non-neoplastic liver parenchyma involved. Our aim was to describe the presentation, treatment, and predictive survival results of noncirrhotic HCC in Veracruz. Materials and methods: A retrospective study, spanning 13 years, was conducted on patients with noncirrhotic HCC. It analyzed their clinical characteristics, fibrosis/cirrhosis biologic index (NAFLD, MELD, ALBI, APRI, CDS, FIB-4, GUCI, LOK) results, disease treatment, and survival. Results: From a total of 168 cases of HCC, 33 (19.6%) noncirrhotic patients were included in the study. Of those patients, the mean patient age was 67.3 years (51.5% men), 9.1% had hepatitis C virus infection, and 27.3% were alcoholics. Less than 20% of the patients had biologic indexes suggestive of fibrosis/cirrhosis. Mean tumor size was 7.7 cm and 42.4% of the patients had alpha-fetoprotein (AFP) levels > 15 ng/mL. A total of 52.5% of the tumors were classified as Okuda II and 30.3% of the patients had advanced disease (the Milan criteria). Liver resection was performed on 51.5% of the patients, radiofrequency ablation on 18.2%, and transarterial chemoembolization on 9.1%. The overall 5-year survival rate was 55.4%. Liver resection resulted in the best 5-year survival rate (72.7%). Age > 67 years and elevated AFP levels were associated with poorer survival (p 15 ng/mL. Se clasificaron 52.5% Okuda II y 30.3% enfermedad avanzada (criterios de Milán). Se trataron 51.5% con resección hepática (RH), 18,2% ablación por radiofrecuencia y 9.1% quimioembolización transarterial. La sobrevida global a 5 años de 55,4%. La RH tuvo la mejor supervivencia a 5 años (72.7%). La edad > 67 años y el aumento de AFP se asoció con menor sobrevida (p < 0.05, log-rank). Conclusiones: El CHC en hígado no cirrótico tiene características y sobrevida similar a otros sitios. La RH tiene la mayor sobrevida. Losíndices biológicos de fibrosis no fueron factores de riesgo para la sobrevida.

Keywords

• Carcinoma hepatocelular
• Hígado no cirrótico
• Alfafetoproteína
• Supervivencia
• Resección hepática