Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors

karaoğullarından, ümit; uskudar, oguz; Odabaş, Emre; Ak, Numan Emre; Kuran, Sedef

doi:10.5152/tjg.2023.21791

Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors

Ümit Karaoğullarından, (Department of Gastroenterology, Çukurova University, Adana, Turkey)

Oğuz ÜSKÜDAR, (Department of Gastroenterology, Çukurova University, Adana, Turkey)

Emre Odabaş, (Department of Gastroenterology, Çukurova University, Adana, Turkey)

Numan Emre Ak, (Department of Gastroenterology, Çukurova University, Adana, Turkey)

Sedef Kuran (Department of Gastroenterology, Çukurova University, Adana, Turkey)

Turkish Journal of Gastroenterology

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Yıl: 2023 Cilt: 34 Sayı: 3 Sayfa Aralığı: 262 - 269 Metin Dili: İngilizce DOI: 10.5152/tjg.2023.21791 İndeks Tarihi: 11-05-2023

Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors

Öz:

carcinoma and non-cirrhotic hepatocellular carcinoma also differ. We aimed to determine the clinicopathologic features, tumor charac- teristics, treatment options, and overall survival after diagnosing hepatocellular carcinoma and prognostic factors effective on survival of hepatocellular carcinoma developing in cirrhotic and non-cirrhotic conditions. Methods: In our study, 220 patients aged over 18 years who were histologically diagnosed as having hepatocellular carcinoma were included. The patients were divided into 2 groups as cirrhotic and non-cirrhotic. Results: When the tumor morphologies were examined in our study, it was observed that they were mostly solitary in both groups. Cirrhotic hepatocellular carcinomas had significantly higher rates of invasion than the non-cirrhotic group (35.3% vs. 20.3%, respec- tively) (P < .05). The survival rate was found to be better in the non-cirrhotic group (17.5 months vs. 11.5 months) (P < .05). Age, maximal tumor diameter, and morphologically infiltrative tumor character were found to be independent risk factors affecting survival in patients with cirrhosis. Portal vein invasion, alfa-fetoprotein, and the absence of an underlying risk factor in the etiology were observed as inde- pendent risk factors affecting survival in patients with non-cirrhosis. Conclusion: Cirrhotic hepatocellular carcinoma and non-cirrhotic hepatocellular carcinoma had different clinicopathologic features and risk factors. We analyzed that treatment choice trends were different between the 2 groups. We also observed that the factors that affected survival were different between the 2 groups.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. [CrossRef]
2. Davis GL, Dempster J, Meler JD, et al. Hepatocellular carcinoma: management of an increasingly common problem. Proc (Bayl Univ Med Cent). 2008;21(3):266-280. [CrossRef]
3. Lee DH, Lee JM. Primary malignant tumours in the non-cirrhotic liver. Eur J Radiol. 2017;95:349- 361. [CrossRef]
4. Giannini EG, Marenco S, Bruzzone L, et al. Hepatocellular carci- noma in patients without cirrhosis in Italy. Dig Liver Dis. 2013;45(2):164-169. [CrossRef]
5. El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365(12):1118-1127. [CrossRef]
6. Wörns MA, Bosslet T, Victor A, et al. Prognostic factors and out- comes of patients with hepatocellular carcinoma in non-cirrhotic liver. Scand J Gastroenterol. 2012;47(6):718-728. [CrossRef]
7. Schütte K, Kipper M, Kahl S, et al. Clinical characteristics and time trends in etiology of hepatocellular cancer in Germany. Digestion. 2013;87(3):147-159. [CrossRef]
8. Stroffolini T, Sagnelli E, Sagnelli C, et al. Decreasing role of HCV and HBV infections as aetiological factors of hepatocellular carci- noma in Italy. Infection. 2019;47(5):805-810. [CrossRef]
9. Baecker A, Liu X, La Vecchia C, Zhang ZF. Worldwide inci- dence of hepatocellular carcinoma cases attributable to major risk factors. Eur J Cancer Prev. 2018;27(3):205-212. [CrossRef]
10. Farinati F, Vitale A, Spolverato G, et al. Development and valida- tion of a new Prognostic System for patients with Hepatocellular Carcinoma. ITA.LI. PLOS Med. 2016;13(4):e1002006. [CrossRef]
11. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and man- agement of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatol- ogy. 2018;68(2):723-750. [CrossRef]
12. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236. [CrossRef]
13. Trevisani F, Frigerio M, Santi V, Grignaschi A, Bernardi M. Hepa- tocellular carcinoma in non-cirrhotic liver: a reappraisal. Dig Liver Dis. 2010;42(5):341-347. [CrossRef]
14. Bonacini M, Hadi G, Govindarajan S, Lindsay KL. Utility of a dis- criminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1997;92(8):1302-1304.
15. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepa- tology. 1996;24(2):289-293. [CrossRef]
16. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402. [CrossRef]
17. Wong VW, Chan WK, Chitturi S, et al. TheAsia-pacificworkingpar ty on non-alcoholic fatty liver disease Guidelines 2017part1: defini- tion, risk factors and assessment. J Gastroenterol Hepatol. 2018;33(1):70-85. [CrossRef]
18. Cabezas J, Bataller R. Alcoholic liver disease: new UK alcohol guidelines and dry January: enough to give up boozing? Nat Rev Gas- troenterol Hepatol. 2016;13(4):191-192. [CrossRef]
19. Deleve LD, Valla DC, Garcia-Tsao G, American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology. 2009;49(5):1729-1764. [CrossRef]
20. Piscaglia F, Gianstefani A, Ravaioli M, et al. Criteria for diagnos- ing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transpl. 2010;16(5):658-667. [CrossRef]
21. Hu S, Zhang J, Cheng C, Liu Q, Sun G, Zuo C. The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein throm- bosis. Abdom Imaging. 2014;39(6):1221-1227. [CrossRef]
22. Liu CJ, Chen BF, Chen PJ, et al. Role of hepatitis B virus precore/ core promoter mutations and serum viral load on noncirrhotic hepatocellular carcinoma: a case–control study. J Infect Dis. 2006;194(5):594-599. [CrossRef]
23. Yuen MF, Tanaka Y, Shinkai N, et al. Risk for hepatocellular car- cinoma with respect to hepatitis B virus genotype B/C, specific mutations of enhancer II/core promoter/precore regions and HBV DNA levels. Gut. 2008;57(1):98-102. [CrossRef]
24. Guo X, Jin Y, Qian G, Tu H. Sequential accumulation of the muta- tions in core promoter of hepatitis B virus is associated with the development of hepato- cellular carcinoma in Qidong, China. J Hepatol. 2008;49(5):718-725. [CrossRef]
25. Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208-1236. [CrossRef]
26. Van Meer S, Van Erpecum KJ, Sprengers D, et al. Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: results from a large cohort in the Netherlands. Eur J Gastroenterol Hepatol. 2016;28(3):352-359. [CrossRef]
27. Weinmann A, Koch S, Niederle IM, et al. Trends in epidemiol- ogy, treatment, and sur- vival of hepatocellular carcinoma patients between 1998 and 2009: an analysis of 1066 cases of a German HCC Registry. J Clin Gastroenterol. 2014;48(3):279-289. [CrossRef]
28. Yen YH, Cheng YF, Wang JH, Lin CC, Wang CC. Characteristics and etiologies of hepatocellular carcinoma in patients without cirrhosis: when East meets West. PLoS One. 2021;16(1):e0244939. [CrossRef]
29. Witjes CD, De Man RA, Eskens FA, et al. Hepatocellular carci- noma: the significance of cirrhosis for treatment and prognosis – retrospective study. Ned Tijdschr Geneeskd. 2010;154:A1747.
30. Jamwal R, Krishnan V, Kushwaha DS, Khurana R. Hepatocellular carcinoma in non-cirrhotic versus cirrhotic liver: a clinico-radiologi- cal comparative analysis. Abdom Radiol (NY). 2020;45(8):2378- 2387. [CrossRef]
31. Connolly GC, Chen R, Hyrien O, et al. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocel- lular carcinoma. Thromb Res. 2008;122(3):299-306. [CrossRef]
32. Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma: current best practice and future direction. Gastroenterology. 2019;157(1):54-64. [CrossRef]
33. Zheng Y, Zhu M, Li M. Effects of alpha-fetoprotein on the occur- rence and progression of hepatocellular carcinoma. J Cancer Res Clin Oncol. 2020;146(10):2439-2446. [CrossRef]
34. Gaddikeri S, Mcneeley MF, Wang CL, et al. Hepatocellular carci- nomainthenoncirrhoticliver.AJRAmJRoentgenol.2014;203(1):W34- W47. [CrossRef]
35. Kim SS, Lee S, Kim MJ. Prognostic factors of gadoxetic acid- enhanced MRI for postsurgical outcomes in multicentric hepatocel- lular carcinoma. Eur Radiol. 2021;31(5):3405-3416. [CrossRef]
36. Hu J, Zhang ZQ, Zhu W, et al. Comparison of clinicopathological traits and prognostic factors of hepatocellular carcinoma with and without cirrhotic background. Carcinogenesis. 2020;41(11):1576- 1582. [CrossRef]

APA	karaoğullarından ü, uskudar o, Odabaş E, Ak N, Kuran S (2023). Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. , 262 - 269. 10.5152/tjg.2023.21791
Chicago	karaoğullarından ümit,uskudar oguz,Odabaş Emre,Ak Numan Emre,Kuran Sedef Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. (2023): 262 - 269. 10.5152/tjg.2023.21791
MLA	karaoğullarından ümit,uskudar oguz,Odabaş Emre,Ak Numan Emre,Kuran Sedef Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. , 2023, ss.262 - 269. 10.5152/tjg.2023.21791
AMA	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. . 2023; 262 - 269. 10.5152/tjg.2023.21791
Vancouver	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. . 2023; 262 - 269. 10.5152/tjg.2023.21791
IEEE	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S "Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors." , ss.262 - 269, 2023. 10.5152/tjg.2023.21791
ISNAD	karaoğullarından, ümit vd. "Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors". (2023), 262-269. https://doi.org/10.5152/tjg.2023.21791

APA	karaoğullarından ü, uskudar o, Odabaş E, Ak N, Kuran S (2023). Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. Turkish Journal of Gastroenterology, 34(3), 262 - 269. 10.5152/tjg.2023.21791
Chicago	karaoğullarından ümit,uskudar oguz,Odabaş Emre,Ak Numan Emre,Kuran Sedef Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. Turkish Journal of Gastroenterology 34, no.3 (2023): 262 - 269. 10.5152/tjg.2023.21791
MLA	karaoğullarından ümit,uskudar oguz,Odabaş Emre,Ak Numan Emre,Kuran Sedef Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. Turkish Journal of Gastroenterology, vol.34, no.3, 2023, ss.262 - 269. 10.5152/tjg.2023.21791
AMA	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. Turkish Journal of Gastroenterology. 2023; 34(3): 262 - 269. 10.5152/tjg.2023.21791
Vancouver	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors. Turkish Journal of Gastroenterology. 2023; 34(3): 262 - 269. 10.5152/tjg.2023.21791
IEEE	karaoğullarından ü,uskudar o,Odabaş E,Ak N,Kuran S "Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors." Turkish Journal of Gastroenterology, 34, ss.262 - 269, 2023. 10.5152/tjg.2023.21791
ISNAD	karaoğullarından, ümit vd. "Hepatocellular Carcinoma in Cirrhotic Versus Noncirrhotic Livers: Clinicomorphologic Findings and Prognostic Factors". Turkish Journal of Gastroenterology 34/3 (2023), 262-269. https://doi.org/10.5152/tjg.2023.21791