Comparative analysis of liver resection in Non-B Non-C and hepatitis virus-associated hepatocellular carcinoma

Background: The incidence of non-hepatitis B and non-hepatitis C hepatocellular carcinoma (NBNC-HCC) is increasing in our country. This study assesses the feasibility of employing an identical surgical treatment strategy for resectable NBNC-HCC as that for hepatitis virus-associated HCC (HV-HCC). Methods: A retrospective analysis (1993 -2023) of 1321 curative liver resections for HCC at a single institution was performed. Propensity score matching ensured a balanced comparison of preoperative clinical factors, including tumor status and background liver condition. Results: The proportion of NBNC-HCC cases has gradually increased, reaching up to 70 %. After matching, 294 of 473 NBNC-HCC patients and 294 of 848 HV-HCC patients were compared. Operative outcomes, including operation time, blood loss, type of surgical procedure, and morbidity, were comparable. Long -term outcome analysis showed similar recurrence-free survival (HR: 0.86, 95 % CI: 0.70 -1.06, P = 0.167) and overall survival (HR: 0.98, 95 % CI: 0.79 -1.23, P = 0.865) for NBNC-HCC. Multivariable analysis identified ICGR15 >= 15 %, ALBI grade 2 or 3, aspartate aminotransferase >= 40, tumor size > 5 cm, multiple tumors, macrovascular invasion, and microvascular invasion as independent prognostic factors for overall survival, while hepatitis B or C virus status lost significance. Conclusions: Despite the increasing incidence of NBNC-HCC, comparable outcomes were achieved between the two groups of matched cohort.