Prognosis of Patients With HCC in the Non-cirrhotic Liver
Prognosis of Patients With HCC in the Non-cirrhotic Liver
The incidence of hepatocellular carcinoma (HCC) is constantly rising throughout the world with the majority of cases in Asia and Africa due to the high prevalence of hepatitis B virus (HBV) infection. Although Europe is still considered to be a low incidence area, the incidence of HCC in Germany has risen to 6.2 cases/100 000/year with a high mortality of 5.2/100 000/year. HCC develops predominantly in the condition of chronic inflammation evolving into liver cirrhosis (LC). Therefore liver function in addition to tumor stage and patient related factors has a major impact on treatment decision and prognosis in case of HCC.
The proportion of patients with HCC diagnosed in a non-cirrhotic liver (NCL) varies throughout different geographic regions of the world ranging from 7% to 54% and depends strongly on the leading risk factor for hepatocarcinogenesis. In Western countries, 15%-20% of HCCs are diagnosed in the absence of LC. Most reports on these patients are from surgically treated cohorts of patients that have undergone curative resection with an obvious selection bias. Data on patients with HCC in NCL in more advanced stages with respect to clinical features and factors influencing survival are scarce in Europe.
Strikingly, previous studies reveal a lower male preponderance of HCC in NCL than in LC. The three main risk factors for HCC (HBV or HCV infection and alcohol abuse) are less frequent than in patients with LC. Patients with HCC in NCL present at more advanced tumor stages than patients with HCC in LC because tumors are generally detected when the disease has become symptomatic. The reason for this is that HCC in LC are frequently detected during surveillance ultrasound. However, a larger proportion of patients with HCC in NCL can be treated with curative intent because hepatic resections without the risk of postoperative liver failure are more likely. The absence of advanced underlying chronic liver disease leads to the fact that the tumor burden is the most significant factor influencing survival among further tumor-related, demographic and etiological factors.
Background
The incidence of hepatocellular carcinoma (HCC) is constantly rising throughout the world with the majority of cases in Asia and Africa due to the high prevalence of hepatitis B virus (HBV) infection. Although Europe is still considered to be a low incidence area, the incidence of HCC in Germany has risen to 6.2 cases/100 000/year with a high mortality of 5.2/100 000/year. HCC develops predominantly in the condition of chronic inflammation evolving into liver cirrhosis (LC). Therefore liver function in addition to tumor stage and patient related factors has a major impact on treatment decision and prognosis in case of HCC.
The proportion of patients with HCC diagnosed in a non-cirrhotic liver (NCL) varies throughout different geographic regions of the world ranging from 7% to 54% and depends strongly on the leading risk factor for hepatocarcinogenesis. In Western countries, 15%-20% of HCCs are diagnosed in the absence of LC. Most reports on these patients are from surgically treated cohorts of patients that have undergone curative resection with an obvious selection bias. Data on patients with HCC in NCL in more advanced stages with respect to clinical features and factors influencing survival are scarce in Europe.
Strikingly, previous studies reveal a lower male preponderance of HCC in NCL than in LC. The three main risk factors for HCC (HBV or HCV infection and alcohol abuse) are less frequent than in patients with LC. Patients with HCC in NCL present at more advanced tumor stages than patients with HCC in LC because tumors are generally detected when the disease has become symptomatic. The reason for this is that HCC in LC are frequently detected during surveillance ultrasound. However, a larger proportion of patients with HCC in NCL can be treated with curative intent because hepatic resections without the risk of postoperative liver failure are more likely. The absence of advanced underlying chronic liver disease leads to the fact that the tumor burden is the most significant factor influencing survival among further tumor-related, demographic and etiological factors.
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