• Tohru Utsunomiya, Mitsuo Shimada, Masatoshi Kudo, Takafumi Ichida, Osamu Matsui, Namiki Izumi, Yutaka Matsuyama, Michiie Sakamoto, Osamu Nakashima, Yonson Ku, Tadatoshi Takayama, Norihiro Kokudo, and Liver Cancer Study Group of Japan.
• *Department of Surgery, The University of Tokushima, Tokushima, Japan †Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Higashiosaka City, Japan ‡Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Shizuoka, Japan §Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan ¶Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan ‖Department of Biostatistics, School of Public Health, University of Tokyo, Japan **Department of Pathology, Keio University School of Medicine, Tokyo, Japan ††Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume City, Japan ‡‡Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan §§Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan; and ¶¶Department of Hepatobiliary and Pancreatic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
• Ann. Surg.. 2015 Mar 1;261(3):513-20.

ObjectiveTo compare the prognostic factors and outcomes after hepatic resection among patients with hepatitis B virus (HBV)-positive, hepatitis C virus (HCV)-positive, and negative for hepatitis B surface antigen and hepatitis C antibody, so-called "NBNC"-hepatocellular carcinoma (HCC) using the data from a nationwide survey.BackgroundThe incidence of NBNC-HCC is rapidly increasing in Japan.MethodsA total of 11,950 patients with HBV-HCC (n = 2194), HCV-HCC (n = 7018), or NBNC-HCC (n = 2738) who underwent a curative hepatic resection were enrolled in this study. The clinicopathological features were compared among the groups. The significant prognostic variables determined by univariate analysis were subjected to a multivariate analysis using a Cox proportional hazard regression model.ResultsLiver function in the HCV-HCC group was significantly worse than that in the HBV-HCC and NBNC-HCC groups. The NBNC-HCC group had significantly more advanced HCC than the HCV-HCC group. The 5-year overall survival rates after hepatectomy in the HBV-HCC, HCV-HCC, and NBNC-HCC groups were 65%, 59%, and 68%, respectively. The 5-year recurrence-free survival (RFS) rates in these 3 groups were 41%, 31%, and 47%, respectively. Stratifying the RFS rates according to the TNM stage showed that the NBNC-HCC group had a significantly better prognosis than the HBV-HCC group in stages II, III, and IVA, and a significantly better prognosis than the HCV-HCC group in stages I and II. Multivariate analysis revealed a significantly better RFS rate in the NBNC-HCC group.ConclusionsThe findings of this nationwide survey indicated that patients with NBNC-HCC had a significantly lower risk of HCC recurrence than those with HBV-HCC and HCV-HCC.

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