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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Long-term prognosis after resection of cryptogenic hepatocellular carcinoma

BMC Surgery > Ausgabe 1/2015
Yu Ohkura, Kazunari Sasaki, Masamichi Matsuda, Masaji Hashimoto, Goro Watanabe
Wichtige Hinweise

Competing interest

We have no conflict of interest to declare.

Authors’ contributions

Yu Ohkura and Kazunari Sasaki contributed equally to this work; Yu Ohkura and Kazunari Sasaki designed and conducted the research, contributed new reagents and analytic tools, analyzed the data, and wrote the paper. Yu Ohkura drafted the article, revised it critically for important intellectual content, and gave final approval for the content; Yu Ohkura, Kazunari Sasaki, Masamichi Matsuda, Masaji Hashimoto, Goro Watanabe created study materials or recruited patients. All authors read and approved the final manuscript.



We investigated the patterns and predictors of recurrence and survival in cryptogenic non-B, non-C, non-alcoholic hepatocellular carcinoma (CR-HCC). We compared the findings with those hepatitis virus B (B) and hepatitis virus C (C)-HCC. CR-HCC does not include HCC developed on NASH.


From 1990 to 2011, of 676 patients who underwent primary curative liver resection as initial therapy for HCC at our institution, 167 had B-HCC, 401 had C-HCC, and 62 had CR-HCC. Differences between three groups were analyzed using the Chi-squared test. Cumulative overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method, prognostic factors involved in OS/DFS were evaluated by univariate analysis using the log-rank test, and stepwise Cox regression analysis.


Liver function was better in CR-HCC than in B/C-HCC, and mean tumor size was larger in CR-HCC than in B/C-HCC. In CR-HCC, OS was equivalent to that of B/C-HCC, and DFS was equivalent to that of B-HCC. Both tumor-related factors and background liver function appeared to be prognostic factors for three groups.


Our findings indicate that the probability of survival of advanced CR-HCC was not longer than that of B/C-HCC. Given our findings, a postoperative follow-up protocol for CR-HCC should be established alongside that for B/C-HCC.
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