• Tohru Utsunomiya, Mitsuo Shimada, Masatoshi Kudo, Takafumi Ichida, Osamu Matsui, Namiki Izumi, Yutaka Matsuyama, Michiie Sakamoto, Osamu Nakashima, Yonson Ku, Norihiro Kokudo, Masatoshi Makuuchi, and Liver Cancer Study Group of Japan.
• *Department of Surgery, The University of Tokushima, Japan †Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Japan ‡Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Japan §Department of Radiology, Kanazawa University Graduate School of Medical Science, Japan ¶Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Japan ‖Department of Biostatistics, School of Public Health, University of Tokyo, Japan **Department of Pathology, Keio University School of Medicine, Japan ††Department of Clinical Laboratory Medicine, Kurume University Hospital, Japan ‡‡Department of Surgery, Kobe University Graduate School of Medicine, Japan §§Department of Hepatobiliary and Pancreatic Surgery, University of Tokyo Graduate School of Medicine, Japan; and ¶¶Department of Surgery, Japanese Red Cross Medical Center, Japan.
• Ann. Surg.. 2014 Feb 1;259(2):336-45.

ObjectiveTo 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.BackgroundThe proportion of non-B non-C HCC is rapidly increasing in Japan.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

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