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Nationwide Study of 4741 Patients With Non-B Non-C Hepatocellular Carcinoma With Special Reference to the Therapeutic Impact

Utsunomiya, Tohru MD, PhD*; Shimada, Mitsuo MD, PhD*; Kudo, Masatoshi MD, PhD; Ichida, Takafumi MD, PhD; Matsui, Osamu MD, PhD§; Izumi, Namiki MD, PhD; Matsuyama, Yutaka MD, PhD; Sakamoto, Michiie MD, PhD**; Nakashima, Osamu MD, PhD††; Ku, Yonson MD, PhD‡‡; Kokudo, Norihiro MD, PhD§§; Makuuchi, Masatoshi MD, PhD; Liver Cancer Study Group of Japan¶¶; Liver Cancer Study Group of Japan

doi: 10.1097/SLA.0b013e31829291e9
Original Articles

Objective: To examine the prognostic factors and outcomes after several types of treatments in patients with hepatocellular carcinoma (HCC) negative for hepatitis B surface antigen and hepatitis C antibody, so-called “non-B non-C HCC” using the data of a nationwide survey.

Background: The proportion of non-B non-C HCC is rapidly increasing in Japan.

Methods: A total of 4741 patients with non-B non-C HCC, who underwent hepatic resection (HR, n = 2872), radiofrequency ablation (RFA, n = 432), and transcatheter arterial chemoembolization (TACE, n = 1437) as the initial treatment, were enrolled in this study. The exclusion criteria included extrahepatic metastases and/or Child-Pugh C. Significant prognostic variables determined by a univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model.

Results: The degree of liver damage in the HR group was significantly lower than that in the RFA and TACE groups. The HR and TACE groups had significantly more advanced HCC than the RFA group. The 5-year survival rates after HR, RFA, and TACE were 66%, 49%, and 32%, respectively. Stratifying the survival rates, according to the TNM stage and the Japan Integrated Staging (JIS) score, showed the HR group to have a significantly better prognosis than the RFA group in the stage II and in the JIS scores “1” and “2.” The multivariate analysis showed 12 independent prognostic factors. HR offers significant prognostic advantages over TACE and RFA.

Conclusions: The findings of this large prospective cohort study indicated that HR may be recommended, especially in patients with TNM stage II and JIS scores “1” and “2” of non-B non-C HCC.

We examined the prognostic factors and outcomes after several types of treatments in 4741 patients with non-B non-C hepatocellular carcinoma (HCC) using the data of a nationwide survey. Our findings indicated that hepatic resection may be recommended, especially in patients with TNM stage II and the Japan Integrated Staging scores “1” and “2” of non-B non-C HCC.

*Department of Surgery, The University of Tokushima, Japan

Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan

Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Japan

§Department of Radiology, Kanazawa University Graduate School of Medical Science, Japan

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Japan

Department of Biostatistics, School of Public Health, University of Tokyo, Japan

**Department of Pathology, Keio University School of Medicine, Japan

††Department of Clinical Laboratory Medicine, Kurume University Hospital, Japan

‡‡Department of Surgery, Kobe University Graduate School of Medicine, Japan

§§Department of Hepatobiliary and Pancreatic Surgery, University of Tokyo Graduate School of Medicine, Japan; and

¶¶Department of Surgery, Japanese Red Cross Medical Center, Japan.

Reprint: Tohru Utsunomiya, MD, PhD, Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto, Tokushima 770-8503, JAPAN. E-mail: utsunomiya@clin.med.tokushima-u.ac.jp.

Disclosure: This work was supported in part by Grants-in-Aid for Scientific Research (C) (24592003) and Grant-in-Aid for Challenging Exploratory Research (22659233), Japan Society for the Promotion of Science. The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

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© 2014 by Lippincott Williams & Wilkins.