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Epidemiologic Variant or Same Problem in a Different Region?

Robert C. G. Martin II, MD; Jennifer Loehle, BS; Charles R. Scoggins, MD; Kelly M. McMasters, MD, PhD

Arch Surg. 2007;142:431-437.

Background  Hepatitis and cirrhosis are common etiologic factors in hepatocellular carcinoma (HCC) in the United States. However, noncirrhotic, nonfibrotic HCC has been recognized more frequently in Kentucky. The aim of this study was to evaluate the epidemiologic features of this variant of HCC.

Hypothesis  Kentucky hepatoma, defined as a noncirrhotic, nonfibrotic, hepatitis-negative HCC, occurs in an older population with more favorable preoperative factors when compared with other patients with HCC.

Design  A prospective review of our 1002 hepatopancreaticobiliary patients, the Kentucky Cancer Registry, and the Surveillance, Epidemiology, and End Results database.

Setting  An academic referral center.

Patients  All patients with HCC treated from January 1, 1999, through September 30, 2005, were reviewed for clinicopathologic factors, recurrence, and outcome.

Results  In a review of the region's 703 patients with HCC, we have seen a 4-fold increase in age-specific HCC diagnosis, with the most rapid increase seen in the 60- to 69-year-old age group. In our institution's 103 patients with HCC, 62 (60.2%) were without hepatitis or cirrhosis. These noncirrhotic, hepatitis-free patients were found to be significantly older (70 vs 55 years; P = .001), to be more often female (40.3% vs 24.4%; P = .01), to have a larger tumor size (6.5 vs 3.9 cm; P = .004), to have fewer liver lesions (1 vs 3; P = .22), and to more frequently undergo surgical therapy (75.6% vs 53.8%; P = .01) than the patients with cirrhosis or hepatitis (n = 41).

Conclusions  A larger percentage of the patients with HCC seen in our region are significantly different from those in other reports throughout the United States in preoperative clinical and pathologic presentation. The reason for this change is as yet unknown, but the incidence continues to rise annually.

Author Affiliations: Division of Surgical Oncology, Department of Surgery, and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Ky.