Skip to main content

Advertisement

Log in

Alcohol consumption and recurrence of non-B or non-C hepatocellular carcinoma after hepatectomy: a propensity score analysis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to identify factors related to the recurrence of non-B or non-C (NBNC) hepatocellular carcinoma (HCC).

Study design

Between April 2000 and March 2012, out of 621 consecutive HCC patients at our institution, 543 who underwent initial hepatectomy and had no extrahepatic metastases were enrolled in the study. Multivariate analysis were performed to identify risk factors for poor disease-free survival (DFS).

Results

The 5-year DFS rate of NBNC (34 %) was better than that of hepatitis virus B (30 %, P = 0.011) and hepatitis virus C (21 %, P < 0.0001), significantly. Multivariate analysis revealed NBNC [hazard ratio (HR), 0.5; 95 % CI, 0.4–0.8; P < 0.0001)] to be an independent factor for DFS rate. We constructed a propensity score matching model with the 543 patients, and the 5-year DFS rates with and without severe alcohol liver disease (ALD) were 31.6 and 47.5 %, respectively (P = 0.013). In the 163 NBNC patients, severe ALD, mild ALD, and no ALD were seen in 35, 56, and 72 patients, respectively. Multivariate analysis revealed a vascular invasion into the hepatic vein (HR, 3.3; 95 % CI, 1.7–6.3; P < 0.0001) and severe ALD (HR, 2.0; 95 % CI, 1.1–3.6; P = 0.020) to be independent risk factors for poor DFS. By propensity score matching between mild and severe ALD, the 5-year DFS rates with severe and mild ALD were 26 and 50 %, respectively (P = 0.035).

Conclusions

The prognoses of NBNC patients were better than those of patients with viral infections. Among the NBNC patients, preoperative excessive alcohol intake decreased DFS rate of HCC occurrence after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AFP:

Alpha-fetoprotein

DCP:

Des-gamma-carboxy prothrombin

DFS:

Disease-free survival

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

NBNC:

Non-B non-C

HR:

Hazard ratio

OS:

Overall survival

References

  1. Suzuki Y, Ohtake T, Nishiguchi S, Hashimoto E, Aoyagi Y, Onji M, et al. Survey of non-B, non-C liver cirrhosis in Japan. Hepatol Res Off J Japan Soc Hepatol. 2012. (Epub 2013/01/26).

  2. Yokoi Y, Suzuki S, Baba S, Inaba K, Konno H, Nakamura S. Clinicopathological features of hepatocellular carcinomas (HCCs) arising in patients without chronic viral infection or alcohol abuse: a retrospective study of patients undergoing hepatic resection. J Gastroenterol. 2005;40(3):274–82 (Epub 2005/04/15).

    Article  PubMed  Google Scholar 

  3. Takenaka K, Yamamoto K, Taketomi A, Itasaka H, Adachi E, Shirabe K, et al. A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma. Hepatology (Baltimore, Md). 1995;22(1):20–4 (Epub 1995/07/01).

    CAS  Google Scholar 

  4. Uetake S, Yamauchi M, Itoh S, Kawashima O, Takeda K, Ohata M. Analysis of risk factors for hepatocellular carcinoma in patients with HBs antigen- and anti-HCV antibody-negative alcoholic cirrhosis: clinical significance of prior hepatitis B virus infection. Alcohol Clin Exp Res. 2003;27(8 Suppl):47S–51S (Epub 2003/09/10).

    Article  PubMed  Google Scholar 

  5. Saibara T. Nonalcoholic steatohepatitis in Asia-Oceania. Hepatol Res Off J Jpn Soc Hepatol. 2005;33(2):64–7 (Epub 2005/11/01).

    Article  Google Scholar 

  6. Yoshiike N, Lwin H. Epidemiological aspects of obesity and NASH/NAFLD in Japan. Hepatol Res Off J Jpn Soc Hepatol. 2005;33(2):77–82 (Epub 2005/10/18).

    Article  Google Scholar 

  7. Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129(1):113–21 (Epub 2005/07/14).

    Article  PubMed  Google Scholar 

  8. Ekstedt M, LE Franzen LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, et al. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology (Baltimore, Md). 2006;44(4):865–73 (Epub 2006/09/29).

    Article  CAS  Google Scholar 

  9. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol. 2008;49(4):608–12 (Epub 2008/08/07).

    Article  PubMed  Google Scholar 

  10. Rafiq N, Bai C, Fang Y, Srishord M, McCullough A, Gramlich T, et al. Long-term follow-up of patients with nonalcoholic fatty liver. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009;7(2):234–8 (Epub 2008/12/04).

    Google Scholar 

  11. Rabe C, Pilz T, Klostermann C, Berna M, Schild HH, Sauerbruch T, et al. Clinical characteristics and outcome of a cohort of 101 patients with hepatocellular carcinoma. World J Gastroenterol WJG. 2001;7(2):208–15 (Epub 2002/01/31).

    CAS  Google Scholar 

  12. Kaczynski J, Hansson G, Hermodsson S, Olsson R, Wallerstedt S. Minor role of hepatitis B and C virus infection in the etiology of hepatocellular carcinoma in a low-endemic area. Scand J Gastroenterol. 1996;31(8):809–13 (Epub 1996/08/01).

    Article  CAS  PubMed  Google Scholar 

  13. Hellerbrand C, Hartmann A, Richter G, Knoll A, Wiest R, Scholmerich J, et al. Hepatocellular carcinoma in southern Germany: epidemiological and clinicopathological characteristics and risk factors. Dig Dis (Basel, Switzerland). 2001;19(4):345–51 (Epub 2002/04/06).

    Article  CAS  Google Scholar 

  14. De Bac C, Stroffolini T, Gaeta GB, Taliani G, Giusti G. Pathogenic factors in cirrhosis with and without hepatocellular carcinoma: a multicenter Italian study. Hepatology (Baltimore, Md). 1994;20(5):1225–30 (Epub 1994/11/01).

    Article  Google Scholar 

  15. Donato F, Tagger A, Gelatti U, Parrinello G, Boffetta P, Albertini A, et al. Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol. 2002;155(4):323–31 (Epub 2002/02/12).

    Article  CAS  PubMed  Google Scholar 

  16. Shiraishi M, Hiroyasu S, Nagahama M, Tomita S, Miyahira T, Kusano T, et al. Characteristics of hepatocellular carcinoma in patients with negative virus markers: clinicopathologic study of resected tumors. World J Surg. 1999;23(3):301–5 (Epub 1999/02/06).

    Article  CAS  PubMed  Google Scholar 

  17. Noguchi K, Nakashima O, Nakashima Y, Shiota K, Nawata H, Kojiro M. Clinicopathologic study on hepatocellular carcinoma negative for hepatitis B surface antigen and antibody to hepatitis C virus. Int J Mol Med. 2000;6(6):661–5 (Epub 2000/11/18).

    CAS  PubMed  Google Scholar 

  18. Kaibori M, Ishizaki M, Matsui K, Kwon AH. Clinicopathologic characteristics of patients with non-B non-C hepatitis virus hepatocellular carcinoma after hepatectomy. Am J Surg. 2012;204(3):300–7 (Epub 2012/05/18).

    Article  PubMed  Google Scholar 

  19. Brechot C, Thiers V, Kremsdorf D, Nalpas B, Pol S, Paterlini-Brechot P. Persistent hepatitis B virus infection in subjects without hepatitis B surface antigen: clinically significant or purely “occult”? Hepatology (Baltimore, Md). 2001;34(1):194–203 (Epub 2001/06/30).

    Article  CAS  Google Scholar 

  20. Torbenson M, Thomas DL. Occult hepatitis B. Lancet Infect Dis. 2002;2(8):479–86 (Epub 2002/08/02).

    Article  PubMed  Google Scholar 

  21. Sato K, Tanaka S, Mitsunori Y, Mogushi K, Yasen M, Aihara A, et al. Contrast-enhanced intraoperative ultrasonography for vascular imaging of hepatocellular carcinoma; clinical and biological significance. Hepatology (Baltimore, Md). 2012. (Epub 2012/11/15).

  22. Mitsunori Y, Tanaka S, Nakamura N, Ban D, Irie T, Noguchi N, et al. Contrast-enhanced intraoperative ultrasound for hepatocellular carcinoma: high sensitivity of diagnosis and therapeutic impact. J Hepato Biliary Pancreat Sci. 2012. (Epub 2012/03/09).

  23. Morse RM, Flavin DK. The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism. JAMA J Am Med Assoc. 1992;268(8):1012–4 (Epub 1992/08/26).

    Article  CAS  Google Scholar 

  24. Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Annu Rev Public Health. 2000;21:121–45 (Epub 2000/07/08).

    Article  CAS  PubMed  Google Scholar 

  25. Ruzzenente A, Guglielmi A, Sandri M, Campagnaro T, Valdegamberi A, Conci S, et al. Surgical resection versus local ablation for HCC on cirrhosis: results from a propensity case-matched study. J Gastrointest Surg Off J Soc Surg Alimentary Tract. 2012;16(2):301–11 (discussion 11. Epub 2011/11/19).

    Article  Google Scholar 

  26. Austin PC, Grootendorst P, Anderson GM. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med. 2007;26(4):734–53 (Epub 2006/05/19).

    Article  PubMed  Google Scholar 

  27. Cochran WG, Rublin DB. Controlling bias in observational studies: a review. Sankhya Series A. 1973;35:417–46.

    Google Scholar 

  28. Nzeako UC, Goodman ZD, Ishak KG. Hepatocellular carcinoma in cirrhotic and noncirrhotic livers. A clinico-histopathologic study of 804 North American patients. Am J Clin Pathol. 1996;105(1):65–75 (Epub 1996/01/01).

    CAS  PubMed  Google Scholar 

  29. Chiesa R, Donato F, Tagger A, Favret M, Ribero ML, Nardi G, et al. Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2000;9(2):213–6 (Epub 2000/03/04).

    CAS  Google Scholar 

  30. Grando-Lemaire V, Guettier C, Chevret S, Beaugrand M, Trinchet JC. Hepatocellular carcinoma without cirrhosis in the West: epidemiological factors and histopathology of the non-tumorous liver. Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire. J Hepatol. 1999;31(3):508–13. (Epub 1999/09/17).

    Google Scholar 

  31. Utsunomiya T, Shimada M, Kudo M, Ichida T, Matsui O, Izumi N, et al. Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact. Ann Surg. 2013. (Epub 2013/05/16).

  32. Chen CJ, Liang KY, Chang AS, Chang YC, Lu SN, Liaw YF, et al. Effects of hepatitis B virus, alcohol drinking, cigarette smoking and familial tendency on hepatocellular carcinoma. Hepatology (Baltimore, Md). 1991;13(3):398–406 (Epub 1991/03/01).

    Article  CAS  Google Scholar 

  33. Yu MW, You SL, Chang AS, Lu SN, Liaw YF, Chen CJ. Association between hepatitis C virus antibodies and hepatocellular carcinoma in Taiwan. Cancer Res. 1991;51(20):5621–5 (Epub 1991/10/15).

    CAS  PubMed  Google Scholar 

  34. Morgan TR, Mandayam S, Jamal MM. Alcohol and hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S87–96 (Epub 2004/10/28).

    Article  CAS  PubMed  Google Scholar 

  35. Alpert ME, Hutt MS, Wogan GN, Davidson CS. Association between aflatoxin content of food and hepatoma frequency in Uganda. Cancer. 1971;28(1):253–60 (Epub 1971/07/01).

    Article  CAS  PubMed  Google Scholar 

  36. Kew MC, Popper H. Relationship between hepatocellular carcinoma and cirrhosis. Semin Liver Dis. 1984;4(2):136–46 (Epub 1984/05/01).

    Article  CAS  PubMed  Google Scholar 

  37. Tamori A, Nishiguchi S, Kubo S, Narimatsu T, Habu D, Takeda T, et al. HBV DNA integration and HBV-transcript expression in non-B, non-C hepatocellular carcinoma in Japan. J Med Virol. 2003;71(4):492–8 (Epub 2003/10/14).

    Article  CAS  PubMed  Google Scholar 

  38. Kannangai R, Molmenti E, Arrazola L, Klein A, Choti M, Thomas DL, et al. Occult hepatitis B viral DNA in liver carcinomas from a region with a low prevalence of chronic hepatitis B infection. J Viral Hepatitis. 2004;11(4):297–301 (Epub 2004/07/03).

    Article  CAS  Google Scholar 

  39. Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B and C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology (Baltimore, Md). 1996;24(2):307–10 (Epub 1996/08/01).

    Article  CAS  Google Scholar 

  40. Wu CC, Ho WL, Chen JT, Tang JS, Yeh DC, P’Eng FK. Hepatitis viral status in patients undergoing liver resection for hepatocellular carcinoma. Br J Surg. 1999;86(11):1391–6 (Epub 1999/12/03).

    Article  CAS  PubMed  Google Scholar 

  41. Kudo A, Mogushi K, Takayama T, Matsumura S, Ban D, Irie T, et al. Mitochondrial metabolism in the noncancerous liver determine the occurrence of hepatocellular carcinoma: a prospective study. J Gastroenterol. 2013. (Epub 2013/04/02).

  42. Zhang YY, Zhou LM. Sirt3 inhibits hepatocellular carcinoma cell growth through reducing Mdm2-mediated p53 degradation. Biochem Biophys Res Commun. 2012;423(1):26–31 (Epub 2012/05/23).

    Article  CAS  PubMed  Google Scholar 

  43. Visek WJ, Shoemaker JD. Orotic acid, arginine, and hepatotoxicity. J Am Coll Nutr. 1986;5(2):153–66 (Epub 1986/01/01).

    Article  CAS  PubMed  Google Scholar 

  44. Laconi E, Vasudevan S, Rao PM, Rajalakshmi S, Pani P, Sarma DS. The development of hepatocellular carcinoma in initiated rat liver after a brief exposure to orotic acid coupled with partial hepatectomy. Carcinogenesis. 1993;14(12):2527–30 (Epub 1993/12/01).

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Atsushi Kudo.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 33 kb)

Supplementary material 2 (TIFF 19764 kb)

Supplemental Fig. 1 Disease-free survival rates of 463 patients in the presence or absence of severe alcohol liver disease (ALD) after adjustment with propensity scores Open squares and open circles denote the HCC patients in the presence and absence of severe ALD, respectively. The difference between the two groups was remarkable (P = 0.013).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kudo, A., Tanaka, S., Ban, D. et al. Alcohol consumption and recurrence of non-B or non-C hepatocellular carcinoma after hepatectomy: a propensity score analysis. J Gastroenterol 49, 1352–1361 (2014). https://doi.org/10.1007/s00535-013-0899-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-013-0899-6

Keywords

Navigation