Comparison Between Patient Characteristics, Aetiology and Outcomes in Patients with and Without Cirrhosis with Hepatocellular Carcinoma Diagnosed in a Regional Centre

Carly Lamb,Jennifer Tham,Tee Lin Goh,Stephen Barclay,Matthew Priest,Ewan H. Forrest,Andrew Fraser, David Kay,Ram Kasthuri,Jeff Evans,Adrian J. Stanley

FRONTLINE GASTROENTEROLOGY（2024）

Queen Elizabeth Univ Hosp | Christie NHS Fdn Trust | Glasgow Royal Infirm | Beatson West Scotland Canc Ctr

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Abstract

Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland.Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland.Methods Data were collected from our prospectively collected database on patient demographics, liver disease aetiology, stage at presentation and outcomes for patients with a diagnosis of HCC confirmed at the Regional West of Scotland multidisciplinary team from 2009 to 2015.Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044).Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044).Results 638 patients were included. 138 (21.6%) did not have cirrhosis and were older at diagnosis than those with cirrhosis (72 years vs 68 years, p=0.001). A higher proportion of those without cirrhosis presented with more advanced HCC (Barcelona clinic liver cancer (BCLC) score B or above; p=0.003). Patients with cirrhosis had median survival of 8 months, compared with those without cirrhosis (11.5 months) but survival was similar in both groups on Kaplan-Meier analysis (p=0.119). There was no difference in survival between these groups when adjusted for cancer stage. Survival was influenced by BCLC score in both cirrhotic and non-cirrhotic groups, as was survival by Child-Pugh score in patients with cirrhosis. Among the patients who underwent transarterial chemoembolisation (TACE), those with cirrhosis had worse survival (p=0.044).Conclusion 21.6% of patients with a new diagnosis of HCC in our region did not have underlying cirrhosis. Patients with non-cirrhotic HCC were diagnosed at an older age, with more advanced stage of HCC. There was no difference in overall survival between patients with HCC with and without cirrhosis, however, survival after TACE was higher in those without cirrhosis.

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hepatocellular carcinoma,liver cirrhosis

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【要点】：本研究比较了苏格兰西部地区患有和未患有肝硬化的肝细胞癌（HCC）患者的临床特征、病因和预后，发现无肝硬化患者诊断年龄更高，疾病阶段更晚，但总体生存期与肝硬化患者相似。

【方法】：通过回顾性分析2009至2015年间在苏格兰西部地区多学科团队确诊的638例HCC患者的前瞻性数据库数据，收集了患者的人口统计学信息、肝病病因、就诊阶段和预后情况。

【实验】：研究了638名HCC患者的数据，其中21.6%的患者没有肝硬化，这些患者的诊断年龄较有肝硬化的患者平均高出4岁，且更多呈现更晚期的HCC（BCLC评分B级或以上）。两组患者的总体生存期在Kaplan-Meier分析中未见显著差异，但在接受肝动脉化疗栓塞（TACE）的患者中，肝硬化患者的生存期较差。使用的数据集为苏格兰西部地区多学科团队的前瞻性数据库。