Peer-review started: August 24, 2018
First decision: October 4, 2018
Revised: October 4, 2018
Accepted: December 22, 2018
Article in press: December 31, 2018
Published online: January 27, 2019
Processing time: 156 Days and 6.3 Hours
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.
Core tip: Hepatocellular carcinoma (HCC) is the 2nd leading cause of cancer related deaths. Majority of HCC arise in a cirrhotic liver, however, 20% of cases can develop in non-cirrhotic liver. This comprehensive review focuses on risk factors, clinical features, diagnostic modalities, management strategies and future directions for HCC in non-cirrhotic liver.