Incidence and Clinical Features of Hepatitis C Virus-associated Hepatocellular Carcinoma Patients Without Liver Cirrhosis in Hepatitis B Virus-endemic Area

Background/objective: Hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) is rarely observed in patients without liver cirrhosis (LC). We evaluated the incidence and clinical feature of HCV-associated HCC patients with or without LC.

Methods: The medical records of 1,516 patients diagnosed as having primary HCC at our hospital between January 2005 and December 2017 were retrospectively reviewed. Of these, 154 (10.2%) HCV-associated HCC patients were analyzed. LC was diagnosed histologically or clinically.

Results: Seventeen (11.0%) of the 154 patients had non-cirrhotic HCC, and all were of Child-Turcotte-Pugh (CTP) class A, Among the 17 patients, 88.2% were male, all had nodular type HCC, and only 2 (11.8%) were under HCC surveillance. Median overall survival (OS) of HCV-associated HCC patients with and without LC was 15 months and 37 months, respectively. Cumulative OS rates were not different between non-cirrhotic patients and cirrhotic patients with CTP class A (=0.229). Cumulative OS rates were significantly higher in non-cirrhotic patients than in cirrhotic patients of CTP class B (<0.001) or C (<0.001). Multivariate analyses showed serum AST (hazard ratio [HR] 1.01, =0.003) and AFP levels (HR 1.01, =0.016), antiviral therapy (HR 0.25, =0.022), and LC of CTP class B (HR, 5.24, =0.006) or C (HR 21.79, <0.001) were significantly associated with prognosis in HCV-associated HCC patients.

Conclusions: HCC in a non-cirrhotic liver was found in 11% of HCV-associated HCC patients. OSs of HCV-associated HCC patients were better in those of CTP A, regardless of LC than in those with LC of CTP class B or C.