Potential etiology, prevalence of cirrhosis, and mode of detection among patients with non-B non-C hepatocellular carcinoma in Korea

Abstract

Background/Aims: We systematically evaluated the clinical characteristics, prevalence of cirrhosis, and mode of detection in virus-unrelated (non-B non-C, NBNC) hepatocellular carcinoma (HCC) patients in Korea. Methods: A total of 447 consecutive treatment-naïve NBNC-HCC adult patients who were registered at the Samsung Medical Center HCC registry in Korea from 2010 to 2013 were analyzed. NBNC was defined as negative hepatitis B surface antigen and negative anti-hepatitis C virus antibody. Presence of cirrhosis was determined based on histological, radiological, endoscopic, and serologic results. Mode of detection was classified as either under surveillance, incidental, or symptomatic. Results: Heavy alcohol use was the most common potential etiology in NBNC-HCC (NBNC-A, alcohol) (59.7%). Ten patients had other identif iable causes (NBNC-O, other identifiable cause) such as autoimmune hepatitis. The rest (38.0%) had no-identifiable cause (NBNC-NA-NO, non-alcohol, no-other identifiable cause). In NBNC-NA-NO group, 83.5% (96/115) of patients with available hepatitis B core immunoglobulin G antibody (HBcIgG) showed HBcIgG positivity, and 80.6% (137/170) had metabolic risk factors (diabetes, obesity, hypertension, and/ or dyslipidemia). Cirrhosis was present in 90.0%, 70.4%, and 60.0% of NBNC-O, NBNC-A, and NBNC-NA-NO patients, respectively. The proportion of patients diagnosed under surveillance was 25.5% across all patients, with specific proportions being 80.0%, 27.7%, and 18.8% for NBNC-O, NBNC-A, and NBNC-NA-NO, respectively. Conclusions: Among NBNC-HCC patients, heavy alcohol use or any other identifiable cause was not found in 38.0%. These NBNC-NA-NO HCC patients showed a high prevalence of HBcIgG positivity and metabolic risk factors, suggesting that prior hepatitis B virus infection and metabolic risk factors may be major contributing factors in the hepatocarcinogenesis in NBNC-NA-NO patients.

Diagnostic Value of Serum Biomarkers for Patients Undergoing Curative Resection with Non-B, Non-C Hepatocellular Carcinoma

“…13 But, other studies found that alcohol use and any other identifiable cause were not found in up to 38.0% of the NBNC HCC patients. 14 In this study, it is found that the proportion of HBcAbpositive was up to 80% in all NBNC HCC cases. The fatty liver and alcohol liver were less than 20% in the NBNC HCC cases and the proportion of cirrhosis was less than 40%.…”

Comparison of clinical features and outcomes between HBV-related and non-B non-C hepatocellular carcinoma

“…HBV infection is the main cause of HCC [1,2]. But the mechanisms of carcinogenesis are different compared with NBNC-HCC [20,22]. HBV is a DNA virus that causes malignant transformation of hepatocytes mainly through gene integration into chromosomes and activation of oncogenes [25][26][27][28].…”

“…However, both of them are caused by chronic viral infection. The etiology of NBNC-HCC is mostly a metabolic factor [20,21]. The tumor physiological characteristics are quite different from HCC caused by HBV and HCV.…”

Associations of general obesity and central obesity with the risk of hepatocellular carcinoma in a Korean population: A national population‐based cohort study

“…However, in the United States, the incidence of HCC has increased 3‐fold since the mid‐1970s 12 in conjunction with the increasing prevalence of diabetes 13 and obesity 14 . Therefore, the contribution of metabolic disorders to the risk of HCC is more important than in the past 15 …”

“…14 Therefore, the contribution of metabolic disorders to the risk of HCC is more important than in the past. 15 Numerous previous studies have shown an association between general obesity and HCC. [16][17][18][19][20] To date, body mass index (BMI) has been used as an anthropometric measurement for adiposity in most studies.…”