Impact of Etiological Shifts and the Rising Burden of Non-B Non-C Hepatocellular Carcinoma on Surveillance and Prognosis: Insights From a 20-Year Retrospective Observational Study.

内容摘要

This study evaluated surveillance impact on outcomes in 1143 patients with first-onset hepatocellular carcinoma (HCC) treated between 2003 and 2023, focusing on the etiological shift toward non-B non-C (NBNC) liver disease. Patients were stratified by etiology: hepatitis B virus (HBV, n&#xa0;=&#xa0;182), hepatitis C virus (HCV, n&#xa0;=&#xa0;555), and NBNC (n&#xa0;=&#xa0;375). Surveillance was defined as &#x2265; 1 annual imaging examination. We assessed surveillance impact on overall survival (OS) using multivariable Cox regression analysis and analyzed diagnostic modalities and tumor markers stratified by etiology. Over the 20-year period, HCV-related HCC decreased whereas NBNC--HCC significantly increased, mainly driven by SLD. A total of 654 patients (58.8%) underwent regular surveillance. Compared with nonsurveilled patients, surveillance patients had significantly higher early-stage diagnosis (79.8% vs. 36.9% and p&#xa0;<&#xa0;0.001) and curative treatment rates (52.8% vs. 21.6% and p&#xa0;<&#xa0;0.001). Multivariable analysis confirmed surveillance as an independent prognostic factor for OS (n&#xa0;=&#xa0;1,085, hazard ratio: 0.61, and p&#xa0;<&#xa0;0.001). Notably, in the NBNC group, nearly 60% of early-stage cases were detected via CT/MRI, significantly higher than in viral etiologies. Furthermore, des-gamma-carboxy prothrombin (DCP)-only positivity was highest in patients with NBNC (22.4%), whereas AFP-only positivity was rare (4.5%). Although regular surveillance provides a robust survival benefit independent of liver function, a critical "surveillance gap" persists in the rapidly expanding NBNC population. The high reliance on CT/MRI and DCP in NBNC patients suggests that standard ultrasound and AFP-based strategies may have limitations in this group. Etiology-specific protocols integrating cross-sectional imaging and combined biomarkers warrant further consideration to bridge this gap.