HCC not related to HBV, HCV increases over time
The fibrosis-4 index may be a useful screening method for hepatocellular carcinoma among patients with non-hepatitis B and non-hepatitis C virus, according to research published in BMC Gastroenterology.
“According to our previous study, 67% and 17% of HCCs were related to HCV–HCC and HBV–HCC, respectively. Fifteen percent of those cases were negative for antibody to HCV and hepatitis B surface antigen (non-HBV, non-HCV HCC [NBNC-HCC]),” Yuko Nagaoki, Hiroshuma University, and colleagues wrote. “The incidence of HCV-related HCC has gradually decreased in recent years, whereas the incidence of NBNC-HCC has gradually increased from 10% in 1995 to 19% in 2009. Furthermore, Tateishi et al. reported that the incidence of NBNC-HCC has increased from 10% in 1991 to 32.5% in 2015.”
To investigate the incidence, NBNC etiologies and clinical characteristics of HCC, researchers retrospectively reviewed 2,171 patients diagnosed with HCC between 1992 and 2018. They evaluated biochemical data from each patient at the time of primary HCC diagnosis and divided patients by early (1992-2009) and late (2010-2018) diagnosis. Researchers observed NBNC-HCC occurrence in 23.6% of patients as well as an increased percentage of patients with HCC and NBNC-HCC from 26.5% in 2009 to 46.3% in 2018.
According to medical records, patients with NBNC-HCC in both diagnosis periods were older (median age, 67-73 years) with higher rates of excessive alcohol consumption (62.2% to 65.4%), type 2 diabetes (48.5% to 60.3%), hypertension (48.5% to 57.4%) and hyperlipidemia (39.2% to 53.8%) compared with other groups of patients. While researchers observed an increased median platelet count over time (15.1 x 104/µL vs. 17.9 x 104/µL), the median fibrosis-4 (FIB-4) index decreased (4.37 vs. 3.61).
Additionally, they detected cirrhosis in 72% of patients with NBNC-HCC and nonalcoholic steatohepatitis, 39% of patients with NBNC-HCC and alcoholic liver disease and 16% of patients with NBNC-HCC and cryptogenic hepatitis. Though 70% of the non-malignant liver tissue among patients with NBNC-HCC was not involved with cirrhosis, the median FIB-4 index was significantly lower in patients with cryptogenic HCC.
“The incidence of NBNC-HCC has gradually been increasing. Most recently, 40% of all patients with HCC had NBNC-HCC. Metabolic syndrome was an important risk factor for NBNC-HCC, and HCC was not uncommon in patients who did not have cirrhosis,” Nagaoki and colleagues concluded. “However, the FIB-4 index tended to be higher and could be a useful screening method for HCC.”