Non-hepatitis B Non-hepatitis C Virus-associated Hepatocellular Carcinoma Metabolic Risk Factor Analysis Study

Objective: To understand the incidence of non-hepatitis B non-hepatitis C virusassociated hepatocellular carcinoma(NBNC-HCC),compare the clinicopathological characteristics of hepatitis virus-associated hepatocellular carcinoma and NBNC-HCC,and analyze the metabolic risk factors of NBNC-HCC to provide a theoretical basis for screening and surveillance of non-hepatitis B non-hepatitis C virus-associated hepatocellular carcinoma.Methods: A total of 3090 patients with hepatocellular carcinoma from January 2011 to December 2021 at the Sichuan Provincial People’s Hospital were selected and divided into viral group(n=2472)and non-viral group(n=618)based on hepatitis marker results,and patients in the NBNC-HCC group were divided into abnormal metabolic liver cancer group(n=289),alcoholic liver-related liver cancer group(n=174)based on background liver disease as well as combined metabolic risk factors and other hepatocellular carcinoma group(n=155).General data,laboratory indices,and pathological findings were collected from all liver cancer patients.NBNC-HCC accounted for the change in the proportion of liver cancer using the chi-square trend test.Count data were compared using the chi-square test or Fisher exact test,and measurement data were compared between 2 independent samples using the Mann-Whitney U test,and multiple independent samples were compared using the Kruskal-Wallis test.Results: The proportion of patients with NBNC-HCC in liver cancer increased from13.7% in 2011 to 20.1% in 2021.Compared with patients in the hepatitis virus-associated liver cancer group,patients in the NBNC-HCC group had relatively higher fasting glucose values,BMI,a higher proportion of combined diabetes and hypertension,a relatively lower FIB-4 index,a relatively Fewer patients had ALBI grade 1,AFP negative,single tumour,CNLC stage I.The NBNC-HCC group had a higher proportion of patients with high differentiation and a lower incidence of vascular invasion.Compared with the ALD-HCC group,patients in the metabolic abnormal liver cancer group had relatively lower AST and TB indexes,higher Alb and PLT indexes,a higher proportion of patients with ALBI grade 1 and Child grade A,a lower proportion of cirrhosis,a lower FIB-4index,and a higher proportion of patients with CNLC stage I and stage II.Conclusion: There is an overall increasing trend in the incidence of NBNC-HCC patients over the 11-year period 2011-2021.In NBNC-HCC patients without cirrhosis,HCC surveillance has not been established and FIB-4 may be a useful screening method.Patients in the metabolically abnormal liver cancer group have a lower incidence of cirrhosis and a lower FIB-4 index,and may progress to liver cancer in the absence of cirrhosis or in the early stages of liver fibrosis.