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Carvalho et al. Hepatoma Research 2018;4:15                      Hepatoma Research
               DOI: 10.20517/2394-5079.2018.13


               Original Article                                                              Open Access


               Hepatocellular carcinoma in patients without
               cirrhosis: relevance and clinical characteristics

                                           1
                                                             2
               Kellyane Santana Dias Carvalho , Luciano E. Fonseca , Helma P. Cotrim 1
               1 Medicine School, Universidade Federal da Bahia, Salvador 40110-060, Brazil.
               2 University Hospital Prof. Edgar Santos, Universidade Federal da Bahia, Salvador 40110-060, Brazil.

               Correspondence to: Dr. Helma P. Cotrim, Programa de Pós Graduação em Medicina e Saúde – PPgMS, Complexo Universitário Professor
               Edgard Santos, Rua Augusto Viana, 50 Andar, Canela, Salvador 40110-060, Brazil. E-mail: helmacotrim@gmail.com
               How to cite this article: Carvalho KSD, Fonseca LE, Cotrim HP. Hepatocellular carcinoma in patients without cirrhosis: relevance and
               clinical characteristics. Hepatoma Res 2018;4:15. http://dx.doi.org/10.20517/2394-5079.2018.13
               Received: 24 Feb 2018    First Decision: 21 Mar 2018    Revised: 8 May 2018    Accepted: 8 May 2018    Published: 29 May 2018

               Science Editor: Guang-Wen Cao    Copy Editor: Guang-Zhe Zhu    Production Editor: Huan-Liang Wu


               Abstract
               Aim: The present study evaluated the frequency of hepatocellular carcinoma (HCC) in patients without cirrhosis.


               Methods: HCC patients were recruited from two reference centers for liver disease in Northeast Brazil from 2010
               to 2016. The diagnosis of HCC and cirrhosis was based on international criteria.

               Results: A total of 169 patients were included, and 16% (27) of the patients did not have hepatocellular carcinoma
               in non-cirrhosis (HCC-NC). The mean age of HCC-NC was 64.4 ± 11.3 years, and 74.1% of the patients were male.
               The main risk factors were hepatitis C virus (HCV) in 29.6% (8), nonalcoholic steatohepatitis (NASH) in 14.8% (4)
               and hepatitis B virus (HBV) in 11.1% (3). Histological HCC diagnosis was performed in 81.5% (22) of the patients,
               and in 18.5% (5) of these patients, the diagnosis was performed by ultrasonography, computed tomography or
               nuclear magnetic resonance imaging methods. Single nodules were found in 56% of HCC-NC (14) when assessed
               by imaging methods.


               Conclusion: The frequency of HCC-NC was elevated and more common in males. HCV, NASH and HBV were
               the most frequent risk factors. These data contribute to discussion on future protocols and criteria for the early
               diagnosis and treatment of HCC in patients with chronic liver disease without cirrhosis.

               Keywords: Hepatocellular carcinoma, primary liver tumor, liver cirrhosis




               INTRODUCTION
               Hepatocellular carcinoma (HCC) is the most frequent primary malignant tumor found in the liver. HCC is

                           © The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
                sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
                as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
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