Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact

Ann Surg. 2014 Feb;259(2):336-45. doi: 10.1097/SLA.0b013e31829291e9.


Objective: To examine the prognostic factors and outcomes after several types of treatments in patients with hepatocellular carcinoma (HCC) negative for hepatitis B surface antigen and hepatitis C antibody, so-called "non-B non-C HCC" using the data of a nationwide survey.

Background: The proportion of non-B non-C HCC is rapidly increasing in Japan.

Methods: A total of 4741 patients with non-B non-C HCC, who underwent hepatic resection (HR, n = 2872), radiofrequency ablation (RFA, n = 432), and transcatheter arterial chemoembolization (TACE, n = 1437) as the initial treatment, were enrolled in this study. The exclusion criteria included extrahepatic metastases and/or Child-Pugh C. Significant prognostic variables determined by a univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model.

Results: The degree of liver damage in the HR group was significantly lower than that in the RFA and TACE groups. The HR and TACE groups had significantly more advanced HCC than the RFA group. The 5-year survival rates after HR, RFA, and TACE were 66%, 49%, and 32%, respectively. Stratifying the survival rates, according to the TNM stage and the Japan Integrated Staging (JIS) score, showed the HR group to have a significantly better prognosis than the RFA group in the stage II and in the JIS scores "1" and "2." The multivariate analysis showed 12 independent prognostic factors. HR offers significant prognostic advantages over TACE and RFA.

Conclusions: The findings of this large prospective cohort study indicated that HR may be recommended, especially in patients with TNM stage II and JIS scores "1" and "2" of non-B non-C HCC.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage
  • Biomarkers / blood
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / therapy*
  • Carcinoma, Hepatocellular / virology
  • Catheter Ablation*
  • Chemoembolization, Therapeutic*
  • Female
  • Follow-Up Studies
  • Health Care Surveys
  • Hepatectomy*
  • Hepatitis B Surface Antigens / blood
  • Hepatitis C Antibodies / blood
  • Humans
  • Japan
  • Liver Neoplasms / blood
  • Liver Neoplasms / mortality
  • Liver Neoplasms / therapy*
  • Liver Neoplasms / virology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Survival Rate
  • Treatment Outcome


  • Antineoplastic Agents
  • Biomarkers
  • Hepatitis B Surface Antigens
  • Hepatitis C Antibodies