| BackgroundChronic hepatitis B virus(HBV)and hepatitis C virus(HCV)infection are major causes of hepatocellular carcinoma(HCC).HCC caused by chronic HBV infection accounted for about 70%-80% in China.However,the number of primary liver cancers caused by hepatitis viruses are gradually decreased,owing to the widespread application of vaccines and interferons.Recently it has been found that the prevalence of hepatitis B virus surface antigen-negative and hepatitis C virus antibody-negative hepatocellular carcinoma(NBNC-HCC)significantly increased,which is closely related to obesity and diabetes.However,clinicopathological characteristics and prognosis are undefined between NBNC-HCC and HBV-HCC.Thus,this study was aimed to reveal their differences and to provide references for clinical prevention and treatment.AimsTo compare the differences of clinicopathological characteristics between NBNC-HCC and HBV-HCC;to investigate the differences of prognosis between NBNC-HCC and HBV-HCC in the method of propensity score matching(PSM);to explore the independent risk factors of NBNC-HCC.MethodsA total of 1151 HCC patients with NBNC-HCC(n=118)and HBV-HCC(n=1033)who underwent surgical resection for the first time in our department between January 2009 and December 2011 were included in this study.Clinicopathological characteristics and PSM analysis of survival and recurrence were compared between the two groups.Univariate and multivariate analysis were operated by Cox forward stepwise regression method.The log-rank test was used to assess survival differences.Statistical significance was defined as P < 0.05.Results1.Patients were older with more diabetes and hypertension in NBNC-HCC group than in HBV-HCC group.The serum levels of albumin,platelet and GGT were also higher in NBNC-HCC group,while the prothrombin time,APRI and serum levels of ALT and AST were lower in NBNC-HCC group than in HBV-HCC group.There were significant differences between the two groups in blood loss,hepatic portal occlusion time,tumor size,CD34-positive ratio,liver cirrhosis and CA199.2.Multivariate analysis indicated that ALP(HR=2.867,95%CI:1.549-5.306),APRI(HR=0.51,95%CI:0.293-0.855),ascites(HR=2.464,95%CI:1.099-5.524)and TNM stage(HR=4.318,95%CI:2.326-8.016)were independent poor prognostic factors for overall survival in NBNC-HCC group.ALP(HR=2.957,95%CI:1.603-5.452),PVTT(HR=3.480,95%CI:1.588-7.628),tumor size(HR=3.072,95%CI:1.244-7.588)and satellite nodules(HR=2.558,95%CI:1.485-4.408)were independent poor prognostic factors for recurrence free survival in NBNC-HCC group.3.Before PSM,the 1-,3-and 5-years overall survival rate were 85.6%,61.0% and 52.3% in NBNC-HCC group and 76.7%,52.4% and 42.5% in HBV-HCC group,respectively(P =0.039);the 1-,3-and 5-years recurrence free survival rate were 68.6%,50.8% and 43.1% in NBNC-HCC group and 64.7%,39.6% and 28.6% in HBV-HCC group,respectively(P =0.008).After PSM,the 1-,3-and 5-years overall survival rate were 86.8%,60.4% and 51.4% in NBNC-HCC group and 74.4%,49.4% and 39.8% in HBV-HCC group,respectively(P =0.035);the 1-,3-and 5-years recurrence free survival rate were 68.1%,50.5% and 42.7% in NBNC-HCC group and 58.9%,40.1% and 29.0% in HBV-HCC group,respectively(P =0.018)ConclusionsNBNC-HCC patients were more different from HBV-HCC in clinicopathological characteristics.HCC should be closely monitored and prevented for patients with metabolic syndromes without chronic hepatitis virus infection.ALP,APRI,ascites,TNM staging,PVTT,tumor size and microscopic satellite were independent risk factors for NBNC-HCC.NBNC-HCC patients had a better overall survival and a lower risk of recurrence than the patients in HBV-HCC,which indicated that HBV infection played a key role in the prognosis and the pathogenesis of both had essential difference and also indicated that NBNC-HCC patients should be treated actively in surgery. |
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