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Impact of Hepatic Steatosis on Disease-Free Survival in Patients with Non-B Non-C Hepatocellular Carcinoma Undergoing Hepatic Resection

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although the prevalence of non-B non-C hepatocellular carcinoma (NBNC HCC) has increased, its clinicopathologic characteristics remain unclear.

Methods

We retrospectively analyzed 518 HCC patients who underwent hepatic resection. Hepatitis B surface antigen- and hepatitis C antibody-negative patients were categorized into the NBNC HCC group (n = 145); others were categorized into the hepatitis B or C HCC (BC HCC) group (n = 373). We subdivided the etiologies of NBNC HCC according to alcohol intake and presence of steatosis.

Results

NBNC HCC was associated with nonalcoholic fatty liver disease (NAFLD) (13.1 %), fatty liver disease with moderate alcohol intake (9.0 %), alcoholic liver disease (ALD) (29.7 %), cryptogenic disease (44.1 %), and other known etiologies (4.1 %). The prevalence of obesity, diabetes mellitus, and hypertension was higher and hepatic function was better in the NBNC HCC group, which had significantly larger tumors than the BC HCC group. The entire NBNC HCC group displayed similar overall and disease-free survival as the BC HCC group. Among the subdivisions, NAFLD-associated HCC patients had significantly better disease-free survival than ALD-associated HCC and BC HCC patients. Microvascular invasion (hazard ratio [HR] 2.30; 95 % confidence interval [CI] 1.33–3.96) and steatosis area <5 % of noncancerous region (HR 2.13; 95 % CI 1.21–3.93) were associated with disease-free survival in NBNC HCC patients.

Conclusions

The prognosis of NBNC HCC was similar to that of BC HCC. Among NBNC HCC patients, NAFLD-associated HCC patients had a relatively low recurrence risk. Absence of steatosis in hepatic parenchyma had a significant impact on disease-free survival in NBNC HCC patients.

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Disclosures

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Takahiro Nishio MD, Etsuro Hatano MD, PhD, Kojiro Taura MD, PhD, Masayuki Okuno MD, Yosuke Kasai MD, Satoru Seo MD, PhD, Kentaro Yasuchika MD, PhD, Akira Mori MD, PhD, Toshimi Kaido MD, PhD & Shinji Uemoto MD, PhD

  2. Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Takaki Sakurai MD, PhD

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  1. Takahiro Nishio MD
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  2. Etsuro Hatano MD, PhD
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  3. Takaki Sakurai MD, PhD
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  4. Kojiro Taura MD, PhD
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Corresponding author

Correspondence to Etsuro Hatano MD, PhD.

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Supplementary material 1 (DOCX 33 kb)

Supplemental Figure 1 The components of NAFLD activity score of NAFLD-associated HCC patients.

10434_2014_4181_MOESM3_ESM.tif

Supplemental Figure 2 Comparisons of overall survival rates among the etiologies. The survival line of other known etiology cases was omitted. Median survival time (MST), 95 % CI, and overall survival rate at 5 years (5-year OS rate), are shown below the graph. Blanks in MST and the upper limit of 95 % CI represent unreached. All groups were compared using the log-rank test; the combinations of groups with p < 0.10 were represented.

10434_2014_4181_MOESM4_ESM.tif

Supplemental Figure 3 Comparisons of disease-free survival rates among the etiologies in patients who underwent curative resection. The survival line of other known etiology cases was omitted. Median survival time (MST), 95 % CI, and disease-free survival rate at 5 years (5-year DFS rate) are shown below the graph. Blanks in MST and the upper limit of 95 % CI represent unreached. All groups were compared using the log-rank test; the combinations of groups with p < 0.10 were represented.

10434_2014_4181_MOESM5_ESM.tif

Supplemental Figure 4 Comparison of disease-free survival rates according to the presence of liver cirrhosis in BC HCC patients who underwent curative resection. Median survival time (MST), 95 % CI, and disease-free survival rate at 5 years (5-year DFS rate) are shown below the graph.

10434_2014_4181_MOESM6_ESM.tif

Supplemental Figure 5 Comparison of disease-free survival rates according to the presence of liver cirrhosis in NBNC HCC patients who underwent curative resection. Median survival time (MST), 95 % CI, and disease-free survival rate at 5 years (5-year DFS rate) are shown below the graph.

10434_2014_4181_MOESM7_ESM.tif

Supplemental Figure 6 Comparison of disease-free survival rates according to the presence of steatosis in NBNC HCC patients who underwent curative resection. Median survival time (MST), 95 % CI, and disease-free survival rate at 5 years (5-year DFS rate) are shown below the graph.

10434_2014_4181_MOESM8_ESM.tif

Supplemental Figure 7 Comparison of disease-free survival rates according to the presence of steatosis in BC HCC patients who underwent curative resection. Median survival time (MST), 95 % CI, and disease-free survival rate at 5 years (5-year DFS rate) are shown below the graph.

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Nishio, T., Hatano, E., Sakurai, T. et al. Impact of Hepatic Steatosis on Disease-Free Survival in Patients with Non-B Non-C Hepatocellular Carcinoma Undergoing Hepatic Resection. Ann Surg Oncol 22, 2226–2234 (2015). https://doi.org/10.1245/s10434-014-4181-9

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  • DOI: https://doi.org/10.1245/s10434-014-4181-9

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