Clinical Features And Prognosis Of Non-viral Primary Hepatocellular Carcinoma

Objective Analysis of hepatitis B virus surface antigen-negative and hepatitis C virus antibody-negative hepatocellular carcinoma The clinical characteristics and prognosis of carcinoma(NBNC-HCC).Methods In this study,a retrospective analysis was performed on 56 patients with NBNC-HCC who received the first surgical resection in the Hepatobiliary Surgery Department of Ningxia University General Hospital from January 2010 to January 2020.Including 12 hepatitis B core antibody(HBc Ab)positive patients and 44 HBc Ab negative patients.A total of 286 patients with hepatitis B virus hepatocellular carcinoma(HBV-HCC)were collected.The clinical characteristics and prognosis of NBNC-HCC and HBV-HCC were compared and analyzed.The independent risk factors for recurrence and survival of NBNC-HCC were analyzed by univariate and multivariate analysis,and the patients with positive and negative core antibodies to NBNC-HCC were compared and analyzed for differences in clinical characteristics and prognosis.Results 1.Clinical features;Compared with HBV-HCC group,NBNC group had a higher proportion of patients with diabetes(8.7% vs 17.9%,P = 0.04),a higher proportion of patients with hypertension(20.3% vs 35.7%,P = 0.012),and a higher proportion of patients aged ≥60years(29.7% vs 53.1%,P = 0.000),the proportion of tumor diameter >5cm was higher(37.7%vs 53.6%,P = 0.026).The laboratory examination showed that compared with HBV-HCC group,the alpha fetal protein of NBNC group was significantly lower than that of HBV-HCC group.AFP < 20(44.06% vs 64.29%,P = 0.020),high tumor differentiation(16.4% vs 35.7%,P =0.001),significantly less cirrhosis(72.7% vs 30.4%,P = 0.020),the proportion of microvascular cancer thrombus was higher(13.6% vs 25%,P = 0.032),and the content of albumin(ALB)in NBNC group was lower than that in HBV-HCC group(P = 0.04).The absolute neutrophil count(NEUT)was high(P = 0.021),and the coagulation function was good;Platelet(PLT)number(P= 0.003),prothrombin time(PT)(P = 0.002),activated partial thromboplastin time(P = 0.003)and fibrinogen(FIB)levels(P = 0.000).2.The 1-,3-and 5-year tumor-free survival rates of the NBNC-HCC group were 92.7%,70% and 51.1%,respectively,and the 1-,3-and 5-year tumor-free survival rates of the HBV-HCC group were 61.5%,42.3% and 26.9%,respectively.The tumor-free survival rate of patients in the two groups was estimated by Kaplan-Meier method,and the difference of P =0.000 by log-rank test was statistically significant.The 1-,3-and 5-year overall survival rates of the NBNC-HCC group were 87.5%,68.3% and 53.9%,respectively.The 1-,3-and 5-year overall survival rates of HBV-HCC group were 86.4%,63.9% and 45.9%,respectively.The overall survival rate of patients in the two groups was estimated by Kaplan-Meier method,and there was no statistically significant difference between the two groups by log-rank test(P=0.463).3.Univariate analysis of overall survival of NBNC-HCC patients showed that diabetes,symptom or absence at admission,fibrinogen and alpha-fetoprotein were related to overall survival(P<0.05).COX multivariable factor found that AFP 20-400(HR=5.875,95%CI:1.066-32.391),AFP ≥400(HR=6.7,95%CI: 1.074-41.807),FIB increased(HR=7.581,95%CI:1.5-38.323)and multiple number of tumors(HR=0.035,95%CI: 0.002-0.601)may be independent risk factors for overall survival of patients(both P < 0.05).Symptoms at admission,FIB,GGT,AFP,tumor diameter and microvascular tumor thromboemboli were correlated with tumor-free survival(P < 0.05).Cox multivariate factors showed that AFP 20-400(HR=13.917,95%CI: 2.092-92.604),FIB increased(HR=6.471,95%CI: 1.356-30.891),tumor diameter ≥10cm(HR=81.149,95%CI: 1.549--5.306)and decreased ALB(HR=10.502,95%CI: 1.237-89.175)may be independent risk factors affecting the tumor-free survival of NBNC-HCC patients(both P< 0.05).Conclusion1.The clinical characteristics of NBNC-HCC and HBV-HCC are different.2.The tumor-free survival of NBNC-HCC group was better than that of HBV-HCC group,and there was no significant difference in overall survival between the two groups.3.AFP,FIB and tumor diameter are independent risk factors affecting the tumor-free survival of NBNC-HCC is an independent risk factor affecting the overall survival of NBNC-HCC.