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J Liver Cancer > Volume 14(2); 2014 > Article
Journal of Liver Cancer 2014;14(2):108-114.
DOI: https://doi.org/10.17998/jlc.14.2.108    Published online September 30, 2014.
Cirrhosis in Surgically Resected Hepatitis C-Associated Hepatocellular Carcinoma in a Hepatitis B Endemic Area
Dong Hyun Sinn1, Geum-Youn Gwak1, Yong-Han Paik1, Moon Seok Choi1, Joon Hyeok Lee1, Kwang Cheol Koh1, Jae-Won Joh2, Seung Woon Paik1, Byung Chul Yoo1, Cheol Keun Park3
1Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence:  Dong Hyun Sinn,
Email: dh.sinn@samsung.com
Abstract
Background/Aims
Cirrhosis has generally been considered a prerequisite for hepatitis C virus (HCV)-infected livers to develop hepatocellular carcinoma (HCC), but HCCs that arise in absence of cirrhosis has been reported. We assessed the prevalence and significance of cirrhosis in HCV-related HCC patients who underwent surgical resection.
Methods
A total of 78 HCC patients (65 male [83.3%]; mean age, 64.2 ± 8.6 years) were evaluated for the presence of cirrhosis. Cirrhosis was assessed based on histology, aspartate aminotransferase-to-platelet ratio index (APRI) as well as clinical criteria, such as ascites, varices, thrombocytopenia, splenomegaly, and radiographic configuration of cirrhosis.
Results
Based on histology, cirrhosis, septal fibrosis, periportal fibrosis and no fibrosis was noticed in 33.3%, 60.3%, 5.1% and 1.3% of patients, respectively. The clinical criteria of cirrhosis were present in 76.9% of patients. APRI > 1.0 was seen in 47.4% of patients. There was no evidence of cirrhosis in 18 patients (23.1%), either by histology or clinically. Cirrhosis by histology was an independent factor for overall survival [hazard ratio: 3.87 (95% CI: 1.24 – 12.00), P=0.019].
Conclusions
Quite proportion of HCC patients had no evidence of cirrhosis, either by histology or clinically. Careful follow-up for HCC may be necessary even for non-cirrhotic HCVinfected Korean patients. (J Liver Cancer 2014;14:108-114)
Key Words: Hepatocellular carcinoma; Hepatitis C virus; Cirrhosis
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