Hepatocellular carcinoma in patients without cirrhosis in Italy

Edoardo G. Giannini, Simona Marenco, Linda Bruzzone, Vincenzo Savarino, Fabio Farinati, Paolo Del Poggio, Gian Ludovico Rapaccini, Maria Anna Di Nolfo, Luisa Benvegnù, Marco Zoli, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, Franco Trevisani

Research output: Contribution to journalArticlepeer-review


Background: In the Western world, hepatocellular carcinoma seldom develops in patients without cirrhosis, and reports describing the characteristics of non-cirrhotic patients with hepatocellular carcinoma are rather infrequent. Methods: We evaluated the main clinical characteristics, treatment options, and survival of patients with hepatocellular carcinoma developed in non-cirrhotic liver among the 3027 consecutive cases of hepatocellular carcinoma accrued in the Italian Liver Cancer database during the last 20 years. Results: We identified 52 patients with hepatocellular carcinoma in non-cirrhotic livers (1.7% of all hepatocellular carcinomas), 42 with (80.8%) and 10 without (19.2%) chronic liver disease. In patients without chronic liver disease, median tumour diameter was greater compared to patients with chronic liver disease (7.8 versus 4.0. cm, P= 0.046). Curative treatment was feasible in 20 patients (38.5%). Median overall survival was 26 months and 5-year survival rate was 23.7%. Detection of hepatocellular carcinoma outside surveillance (P= 0.036), advanced hepatocellular carcinoma stage (P<0.0001), and non-curative treatment (P= 0.007) were associated with worse prognosis, but tumour stage was the only independent predictor of survival. Conclusions: In Italy, less than 2% of hepatocellular carcinomas develop in a non-cirrhotic liver, and almost never in a normal liver. These patients frequently present with advanced tumours, have low eligibility rates for curative treatment, and have a dismal prognosis despite their preserved liver function.

Original languageEnglish
Pages (from-to)164-169
Number of pages6
JournalDigestive and Liver Disease
Issue number2
Publication statusPublished - Feb 2013


  • Alpha-fetoprotein
  • Hepatocellular carcinoma
  • Non-cirrhotic liver
  • Survival
  • Treatment

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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