Hepatocellular carcinoma (HCC) is a relatively common cancer and occurs mainly in patients with liver cirrhosis (85%-95%). A significant number of cases are, however, diagnosed in normal and noncirrhotic/nonfibrotic livers. In contrast to HCC in a cirrhotic liver, noncirrhotic hepatocellular carcinoma (NC-HCC) predominantly occurs in young and healthy female patients in their 30s, and the diagnosis is frequently made at an advanced stage in the absence of a clear etiological factor. [1][2][3] The same holds true for the uncommon fibrolamellar hepatocellular carcinoma (FL-HCC) variant. [1][2][3] Several studies have shown that the 3-year overall survival (OS) rates with different pharmaceutical, radiological, and surgical therapies for HCC (if they are adequately performed) are approximately 60%. 4 After 3 years, the results of these treatments start to diverge substantially with respect to OS and, most importantly, with respect to disease-free survival (DFS). Long-term follow-up (5-10 years) has clearly shown that surgical resection is the only curative treatment for any kind of HCC. [2][3][4][5] With respect to very long-term DFS (>5 years), liver transplantation (LT) offers the best results. 2,[4][5][6] In order to be successful, surgery has to be adapted to the tumor, the underlying condition of the patient, and the patient's liver. Liver resection and LT should have complementary roles rather than competing ones, and they should be associated with each other instead of being opposed. 5 Partial resection for HCC can be considered only for patients with well-compensated cirrhosis or fibrosis or with normal liver tissue. For patients with decompensated liver disease, cirrhosis, or a technically unresectable tumor, LT offers the best chance for a cure. This option indeed addresses the tumor as well as the underlying liver disease.
Despite the extensive experience with LT for the treatment of HCC in patients with cirrhosis, the experience with LT for the treatment of NC-HCC is anecdotal and is limited to situations in which resection is not possible.
The aims of this study were as follows: (1) to analyze the results from recent series of partial liver resections for NC-HCC, (2) to compare these results with the results of LT for the same condition; and (3) to propose an adaptation of the therapeutic algorithm for NC-HCC on the basis of these analyses.