P2845 - Hepatocellular Carcinoma in Patients Without Cirrhosis - Characteristics, Etiologies and Trends

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

IG

Isabel Garrido

Centro Hospitalar Universitário de São João, Porto, Portugal

Isabel Garrido, ¹, Pedro Pereira, MD², Guilherme Macedo, MD, PhD, FACG²
¹Centro Hospitalar Universitário de São João, Porto, Porto, Portugal; ²Centro Hospitalar de São João, Porto, Porto, Portugal

Introduction: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Current guidelines recommend surveillance for HCC in those with cirrhosis of any etiology. However, HCC may also develop in non-cirrhotic patients. The aim of this study was to evaluate the characteristics, etiologies, trends and outcomes of non-cirrhotic HCC.

Methods: All histologically confirmed HCC cases diagnosed at the Centro Hospitalar Universitário de São João from January 2010 to December 2020 were identified. Patient, tumor, liver disease characteristics and outcome data were collected. The presence of cirrhosis was assessed by histology.

Results: A total of 131 patients with HCC were enrolled in the study. Among them, 53 (40.5%) were noncirrhotic individuals, the majority males (75.5%), with a median age of 67 years old (IQR 54-76). In these patients, hepatitis C virus infection (15.1%) was the most common liver disease, followed by alcohol (13.2%) and hepatitis B virus (7.5%) infection. However, in most cases (58.5%) the etiology of liver disease/HCC was not identified. Most of them (58.5%) had bridging fibrosis (Metavir score F2-3). As expected, the non-cirrhotic patients had a higher platelet count (240 vs 168 x10⁹/L, p< 0.001) and lower bilirubin levels (2.19 vs 3.05 mg/dL, p=0.002) and prothrombin time (12.3 vs 13.5 sec, p< 0.001) than the cirrhotic patients. Alpha‐fetoprotein was similar in both groups (p=0.954). Patients with non-cirrhotic HCC had larger tumors (82 vs 47 mm, p< 0.001) and were less frequently within Milan criteria (20.8% vs 55.1%, p< 0.001). Nevertheless, they had better overall survival than cirrhotic HCC patients (4.8 vs 1.4 years, p=0.036). Barcelona Clinic Liver Cancer stage 0 and A (OR 0.04, 95% CI 0.007‐0.217, p< 0.001) and surgical resection (OR 0.082, 95% CI 0.018‐0.362, p< 0.001) were associated with reduced risk of death in patients with noncirrhotic HCC. The etiology of underlying liver disease did not affect mortality (p=0.277).

Discussion: In our cohort, a relevant number of HCCs occurred in patients without underlying cirrhosis. The average tumor size was significantly larger in the noncirrhotic patients, possibly due to a lack of surveillance in these individuals. Although noncirrhotic individuals presented with more advanced HCC, their survival was better, probably due to normal underlying liver function, lack of portal hypertension and better performance status at presentation.

Table 1. Clinical characteristics of the study population

	No cirrhosis (n=53)	Cirrhosis (n=78)	P value
Age (years)	67 (54-76)	66 (57-74)	0.990
Male sex	40 (75.5%)	84.6%	0.191
Underlying liver disease HCV infection Alcohol HBV infection NAFLD Haemochromatosis Primary biliary cholangitis Unknown	8 (15.1%) 7 (13.2%) 4 (7.5%) 2 (3.8%) 1 (1.9%) 1 (1.9%) 31 (58.5%)	22 (28.2%) 23 (29.5%) 10 (12.8%) 5 (6.4%) 5 (6.4%) 0 13 (16.7%)	0.654
Platelets (x109/L)	240±96	168±86	< 0.001
Albumin (g/dL)	39.9±4.5	37.9±6.3	0.179
AST (U/L)	67±84	61±56	0.040
ALT (U/L)	61±68	56±70	0.762
GGT (U/L)	164±228	156±145	0.109
ALP (U/L)	170±149	143±97	0.860
Total bilirubin (mg/dL)	3.1±14.4	2.2±6.3	0.002
Creatinine (mg/dL)	1.2±1.6	1.0±0.9	0.412
Prothrombin time (sec)	12.3±1.1	13.5±1.7	0.001
Alpha‐fetoprotein (ng/mL)	1311±4047	319±1777	0.954
Tumour size (mm)	82±57	47±32	< 0.001
Tumour stage Single < 2cm Single >2cm 3 tumours < 3 cm Large multinodular Vascular invasion or extrahepatic spread	3 (5.7%) 34 (64.2%) 2 (3.8%) 9 (17.0%) 5 (9.4%)	4 (5.1%) 41 (52.6%) 6 (7.7%) 19 (24.4%) 8 (10.3%)	0.780
Tumour within Milan criteria	11 (20.8%)	43 (55.1%)	< 0.001
Portal vein thrombosis	2 (3.8%)	7 (9.0%)	0.259
Barcelona clinic liver cancer 0 A B C D	3 (5.7%) 30 (56.6%) 12 (22.6%) 4 (7.5%) 4 (7.5%)	4 (5.1%) 45 (57.7 20 (25.6%) 7 (9.0%) 2 (2.6%)	0.428
Treatment modalities Resection Transarterial chemoembolization Radiofrequency ablation Selective internal radiation therapy Liver transplantation Sorafenib Palliative care Others	31 (58.5%) 5 (9.4%) 1 (1.9%) 4 (7.5%) 0 2 (3.8%) 8 (15.1%) 2 (3.8%)	37 (47.4%) 11 (14.1%) 3 (3.8%) 8 (10.3%) 2 (2.6%) 9 (11.5%) 3 (3.8%) 5 (6.4%)	0.165

Table: AST - aspartate aminotransferase, ALT - alanine aminotransferase, GGT - gamma-glutamyl transferase, ALP - alkaline phosphatase, HCV - hepatitis C virus, HBV - hepatitis B virus, NAFLD - non‐alcoholic fatty liver disease

Disclosures:

Isabel Garrido indicated no relevant financial relationships.

Pedro Pereira indicated no relevant financial relationships.

Guilherme Macedo indicated no relevant financial relationships.

Isabel Garrido, ¹, Pedro Pereira, MD², Guilherme Macedo, MD, PhD, FACG². P2845 - Hepatocellular Carcinoma in Patients Without Cirrhosis - Characteristics, Etiologies and Trends, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.