P221 Non-cirrhotic vs Cirrhotic HCC: comparison between patient characteristics, aetiology and outcomes

IntroductionHepatocellular carcinoma (HCC) causes more than 5,400 deaths per year in the UK and is rising in incidence. Previously in the UK, HCC in non-cirrhotic livers was felt to be uncommon. We sought to establish the proportion of HCC occurring in patients without cirrhosis in our region of the UK and compare characteristics of those with cirrhosis.MethodsData was collected from our prospectively collected database on patient demographics, liver aetiology, stage at presentation and outcome for patients diagnosed with HCC at our regional MDT from 2009 to 2015.ResultsA total of 638 patients with HCC were included. 140 (21.9%) had no underlying cirrhosis. Non-cirrhotic HCCs were older at diagnosis (72 years vs 68 years, p = 0.001), with a similar male to female ratio. Alcohol related liver disease (ArLD) was the most common underlying aetiology in patients with cirrhosis (59%; see table 1), and along with Viral hepatitis was significantly more common than patients without cirrhosis. In contrast, unknown aetiology represented the majority of diagnoses, and was significantly greater in the non-cirrhotic cohort. Patients with non-cirrhotic HCC had more advanced malignant disease at diagnosis compared to cirrhotic HCC using Barcelona Clinic Liver Cancer (BCLC) staging, p < 0.001 (table 1). Liver transplant was performed in 4.2% of patients with cirrhotic HCC compared to no patients with non-cirrhotic HCC. Liver resection was performed in 4% cirrhotic versus 9% non-cirrhotic. Radiofrequency ablation (RFA) was used in 7% and 1.4% of cirrhotic and non-cirrhotic HCC. Transarterial chemoembolization (TACE) was used in 25% cirrhotic and 24% non-cirrhotic HCC. Sorafenib was prescribed in 3% cirrhosis and 6.4% non-cirrhotic HCC, with Sorafenib plus TACE used in 1% cirrhotic and 1.4% non-cirrhotic HCC. 59% and 57% of patients with cirrhosis and non-cirrhotic HCC, respectively, were treated with supportive care only. Median survival was lower in patients with cirrhotic HCC, 19.6 months, compared to non-cirrhotic HCC, 24.5 months, p =0.05.Abstract P221 Table 1Comparison of Aetiology and BCLC staging classification in patients with cirrhosis and non-cirrhosis HCC Cirrhotic (N= 497) Non-cirrhotic (N= 140) P-value Aetiology ArLD 293 (59.0) 45 (32.1)