Clinical characteristics, prognosis, and surgical outcomes of patients with NBNC hepatocellular carcinoma: three-decade observational study

Background: The incidence of non-hepatitis B virus, non-hepatitis C virus hepatocellular carcinoma (NBNC-HCC) is increasing worldwide. We assessed the clinical characteristics and surgical outcomes of NBNC-HCC, versus hepatitis B (HBV-HCC) and hepatitis C (HCV-HCC). Methods: : Etiologies, fibrosis stages, and survival outcomes were analyzed of 789 consecutive patients who underwent surgery from 1990 to 2020 (HBV-HCC, n=149; HCV-HCC, n=424; NBNC-HCC, n=216). Results: : The incidence of hypertension and diabetes mellitus was significantly higher in patients with NBNC-HCC than in those with HBV-HCC and HCV-HCC. Significantly more advanced tumor stages were observed in patients with NBNC-HCC; however, better liver function and lower fibrosis stages were observed. Patients with NBNC-HCC had significantly worse 5-year overall survival than patients with HBV-HCC; overall survival was comparable between patients with NBNC-HCC and HCV-HCC. Patients with HCV-HCC had significantly worse 5-year recurrence-free survival than patients with HBV-HCC and NBNC-HCC. In patients with NBNC-HCC, overall survival was comparable among three periods (1990–2000, 2001–2010, and 2011–2020) despite significant improvement in patients with HBV-HCC and HCV-HCC. Conclusion: The prognosis of NBNC-HCC was similar to that of HBV-HCC and HCV-HCC regardless of tumor progression at surgery. Patients with hypertension, diabetes mellitus, and dyslipidemia require careful systematic follow-up and treatment.