Kentucky hepatoma: epidemiologic variant or same problem in a different region?

Area of Science:

• Hepatology
• Oncology
• Epidemiology

Background:

• Hepatitis and cirrhosis are primary causes of hepatocellular carcinoma (HCC) in the US.
• A distinct form of HCC, noncirrhotic and nonfibrotic, is increasingly observed in Kentucky.
• This study investigates the unique epidemiological features of this HCC variant.

Purpose of the Study:

• To evaluate the epidemiologic characteristics of noncirrhotic, nonfibrotic, hepatitis-negative HCC in Kentucky.
• To compare the clinical and pathological presentation of this HCC variant with traditional HCC cases.

Main Methods:

• Prospective review of 1002 hepatopancreaticobiliary patients.
• Analysis of data from the Kentucky Cancer Registry and SEER database.
• Review of clinicopathologic factors, recurrence, and outcomes for HCC patients from 1999-2005.

Main Results:

• A 4-fold increase in age-specific HCC diagnosis was observed in the region, particularly in the 60-69 age group.
• Of 103 HCC patients at the institution, 60.2% lacked hepatitis or cirrhosis.
• These noncirrhotic, hepatitis-free patients were older, more likely female, had larger tumors, and underwent more surgical therapy compared to cirrhotic/hepatitis patients.

Conclusions:

• A significant proportion of HCC patients in the region exhibit distinct preoperative clinical and pathological features compared to national data.
• The underlying reasons for this epidemiological shift in HCC presentation remain unknown.
• The incidence of this noncirrhotic HCC variant is increasing annually.