Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis

a United States multicentre study

Samer Gawrieh, Lara Dakhoul, Ethan Miller, Andrew Scanga, Andrew deLemos, Carla Kettler, Heather Burney, Hao Liu, Hamzah Abu-Sbeih, Naga Chalasani, Julia Wattacheril

Research output: Contribution to journalArticle

Abstract

Background: Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim: To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres. Methods: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results: Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P <.001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P <.0001]) and NAFLD (0.66% [P =.003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P <.001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P =.004). Conclusions: Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.

Original languageEnglish (US)
JournalAlimentary Pharmacology and Therapeutics
DOIs
StateAccepted/In press - Jan 1 2019

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Multicenter Studies
Hepatocellular Carcinoma
Fibrosis
Liver Diseases
Hepacivirus
Survival
Virus Diseases
Hepatitis B virus
Neoplasms

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

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Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis : a United States multicentre study. / Gawrieh, Samer; Dakhoul, Lara; Miller, Ethan; Scanga, Andrew; deLemos, Andrew; Kettler, Carla; Burney, Heather; Liu, Hao; Abu-Sbeih, Hamzah; Chalasani, Naga; Wattacheril, Julia.

In: Alimentary Pharmacology and Therapeutics, 01.01.2019.

Research output: Contribution to journalArticle

Gawrieh, Samer ; Dakhoul, Lara ; Miller, Ethan ; Scanga, Andrew ; deLemos, Andrew ; Kettler, Carla ; Burney, Heather ; Liu, Hao ; Abu-Sbeih, Hamzah ; Chalasani, Naga ; Wattacheril, Julia. / Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis : a United States multicentre study. In: Alimentary Pharmacology and Therapeutics. 2019.
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title = "Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study",
abstract = "Background: Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim: To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres. Methods: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results: Of 5144 eligible patients with HCC, 11.7{\%} had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9{\%} vs 20.8{\%}) and less frequently black (8.3{\%} vs 12.4{\%}) (P <.001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3{\%}), followed by hepatitis C virus (HCV) (12.1{\%}) and hepatitis B virus (HBV) (10{\%}) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96{\%} [P <.0001]) and NAFLD (0.66{\%} [P =.003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15{\%} vs 39{\%}), more frequently underwent resection (43.6{\%} vs 8{\%}) (P <.001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P =.004). Conclusions: Nearly 12{\%} of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.",
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T1 - Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis

T2 - a United States multicentre study

AU - Gawrieh, Samer

AU - Dakhoul, Lara

AU - Miller, Ethan

AU - Scanga, Andrew

AU - deLemos, Andrew

AU - Kettler, Carla

AU - Burney, Heather

AU - Liu, Hao

AU - Abu-Sbeih, Hamzah

AU - Chalasani, Naga

AU - Wattacheril, Julia

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim: To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres. Methods: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results: Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P <.001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P <.0001]) and NAFLD (0.66% [P =.003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P <.001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P =.004). Conclusions: Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.

AB - Background: Limited data exist on the burden and features of non-cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim: To evaluate characteristics, aetiologies, trends and outcomes of non-cirrhotic HCC from 2000 to 2014 at five large US centres. Methods: Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results: Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non-cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P <.001 for all). Among non-cirrhotic patients, non-alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non-cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P <.0001]) and NAFLD (0.66% [P =.003]). Patients with non-cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P <.001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P =.004). Conclusions: Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non-cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non-cirrhotic patients presented with more advanced HCC, their survival was better.

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