Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: results from a large cohort in the Netherlands: results from a large cohort in the Netherlands

Suzanne van Meer, Karel J. van Erpecum, Dave Sprengers, Minneke J. Coenraad, Heinz-Josef Klümpen, Peter L. M. Jansen, Jan N. M. Ijzermans, Joanne Verheij, Carin M. J. van Nieuwkerk, Peter D. Siersema, Robert A. de Man

Research output: Contribution to journalArticleAcademicpeer-review

46 Citations (Scopus)


Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis. Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features. In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65). HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size
Original languageEnglish
Pages (from-to)352-359
Number of pages8
JournalEuropean Journal of Gastroenterology & Hepatology
Issue number3
Publication statusPublished - Mar 2016


  • Academic Medical Centers
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular
  • Chi-Square Distribution
  • Child
  • Comparative Study
  • Female
  • Hepatectomy
  • Humans
  • Journal Article
  • Kaplan-Meier Estimate
  • Liver Cirrhosis
  • Liver Neoplasms
  • Logistic Models
  • Male
  • Middle Aged
  • Multicenter Study
  • Multivariate Analysis
  • Netherlands
  • Odds Ratio
  • Predictive Value of Tests
  • Prevalence
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Tumor Burden
  • Young Adult

Cite this