Outcomes Following Resection of Hepatocellular Carcinoma in the Absence of Cirrhosis

Background Hepatocellular carcinoma (HCC) occasionally occurs in non-cirrhotic patients; however, outcomes for these patients are not extensively documented. Methods We performed an institutional review of patients without cirrhosis who underwent resection for HCC. Clinical data were evaluated to identify factors impacting recurrence-free survival (RFS) and overall survival (OS). Results Forty-two patients underwent hepatectomy for HCC in the absence of cirrhosis over a 10-year period. Median follow-up was 22 months. For the entire cohort, 1-, 3-, and 5-year RFS was 62%, 42%, and 38% and 1-, 3-, and 5-year OS was 78%, 60%, and 49%, respectively. On univariate analysis, RFS was significantly worse for patients with a disrupted/absent tumor capsule ( p = 0.027), vascular invasion ( p = 0.030), elevated alkaline phosphatase ( p = 0.004), and tumor size > 10 cm ( p = 0.016). OS was significantly worse for patients with a disrupted/absent tumor capsule ( p = 0.044), obesity ( p = 0.036), and elevated alkaline phosphatase ( p = 0.007) with a trend towards decreased OS for tumor size > 10 cm ( p = 0.07). Conclusions Patients undergoing resection for HCC in the absence of cirrhosis have fairly high recurrence and modest survival rates. Pre-operative alkaline phosphatase, tumor size, tumor encapsulation, and vascular invasion are important prognostic factors.