Kokudo Norihiro, Takemura Nobuyuki, Kanto Tatsuya, Tateishi Ryosuke, Igari Toru, Hasegawa Kiyoshi
Department of Surgery, National Center for Global Health and Medicine; Tokyo, Japan.
The Research Center for Hepatitis and Immunology Department of Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
Glob Health Med. 2019 Oct 31;1(1):23-29. doi: 10.35772/ghm.2019.01018.
During the last two decades, there has been a dramatic increase in so-called non-B non-C hepatocellular carcinoma (NBNC HCC) in Japan. Majority of NBNC HCC are considered as so-called metabolic HCC and some could be related to occult HBV infection. Although there have been some reports on histological features predominant in metabolic HCC, very few specific driver genes for NBNC HCC have been reported. Most of the NBNC HCC are found incidentally and are relatively large in size. Since liver function is generally normal or subnormal, such patients have a higher chance for undergoing curative surgery. Although there has been slightly conflicting long-term outcomes reported for NBNC HCC, slightly better outcomes may be expected compared to other etiologies after curative surgery. However, risk of recurrence depends on the background liver. NBNC HCC in cirrhotic patients have a persistently higher risk of tumor recurrence requiring a long-term postoperative surveillance. It would be safe to conclude at this moment that NBNC HCCs should be treated using the same surgical strategy as HCCs with viral origin, same operative indications and same follow-up protocol.
在过去二十年中，日本所谓的非B非C型肝细胞癌（NBNC HCC）显著增加。大多数NBNC HCC被认为是所谓的代谢性HCC，有些可能与隐匿性HBV感染有关。尽管已有一些关于代谢性HCC主要组织学特征的报道，但报道的NBNC HCC特异性驱动基因却很少。大多数NBNC HCC是偶然发现的，且体积相对较大。由于肝功能通常正常或略低于正常水平，这类患者接受根治性手术的机会较高。尽管关于NBNC HCC的长期预后报道略有矛盾，但与其他病因的HCC相比，根治性手术后可能预期有稍好的预后。然而，复发风险取决于肝脏背景。肝硬化患者的NBNC HCC肿瘤复发风险持续较高，需要长期术后监测。目前可以有把握地得出结论，NBNC HCC应采用与病毒源性HCC相同的手术策略、相同的手术指征和相同的随访方案进行治疗。
