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Carvalho et al. Hepatoma Res 2018;4:15 I http://dx.doi.org/10.20517/2394-5079.2018.13 Page 3 of 6

Table 1. Clinical characteristics of hepatocellular carcinoma patients with
and without cirrhosis
Variables Without cirrhosis With cirrhosis
Gender
Male, n (%) 20 (74.1) 110 (77.5)
Female, n (%) 7 (25.9) 32 (22.5)
Age, median ± SD (years) 64.4 ± 11.3 58.8 (± 10.9)
Size, median ± SD (cm) 5.3 ± 2.9 5.49 (± 4.0)
Etiology, n (%) 20 (74) 125 (88)
HCV 8 (29.6) 59 (48.5)
NASH 4 (14.8) 4 (2.8)
HBV 3 (11.1) 14 (10)
Cryptogenic 3 (11.1) 22 (15.5)
ALD 2 (7.4) 24 (17)
Hemochromatosis - 1 (0.7)
Risk factor unknown, n (%) 7 (26) 17 (12)
SD: standard deviation; HCV: hepatitis C virus; NASH: non-alcoholic steatohepatitis;
HBV: hepatitis B virus; ALD: alcoholic liver disease

Histological assessment
Histological evaluation was performed on liver biopsies or surgical samples. The diagnostic criteria for HCC
[15]
were based on the recommendations of the International Consensus Panel .
Statistical analysis
The statistical analyses were descriptive and performed with the Statistical Package for the Social Sciences
(SPSS) software (version 22.0, IBM Corp., USA). The data were analyzed, and the results are expressed as the
mean values, standard deviations, and medians according to the distribution of the variables.

The present study was conducted according to the guidelines established in the 1964 declaration of Helsinki.
The project was approved by the Research Ethics Committee at Bahia Medicine School, Federal University of
Bahia, Brazil. All the participants signed letters of informed consent.

RESULTS
A total of 169 patients with HCC were evaluated, and 16% (27) of the cases were HCC-NC. Table 1 shows the
main clinical characteristics and risk factors of the patients without and with cirrhosis.

Histological analysis was performed in 81.5% of the cases (n = 22). A diagnosis was made by imaging
[16]
methods (CT or MRI) in 18.5% of the cases [Table 2] .

DISCUSSION
The prevalence of HCC-NC in this Brazilian study was elevated (16%), and the results were similar to those
[6-8]
found in other studies conducted in Western countries . The patients were most frequently of advanced
ages (mean of 64.4 years) and predominately male. These data are consistent with the findings of previous
studies, although in other studies, the diagnosis of HCC-NC was more frequent in younger individuals and
in women . This difference may be due to the geographical variations in the prevalence of HCC and its risk
[5]
factors.

Chronic HBV and HCV infections are the most frequent risk factors for HCC in patients with and without
HCC-NC. An estimated 0.1% of individuals with HBV without cirrhosis develop HCC , likely due to the
[9]
[10]
carcinogenic effect of the virus . HCV is described in most studies as being of low potential for developing
HCC in the absence of cirrhosis. However, more recent studies have shown the existence of HCC-NC in
patients with chronic hepatitis HCV, suggesting that other mechanisms independent of cirrhosis would
affect hepatocarcinogenesis [5,11] .