Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009

Abstract

Hepatocellular carcinoma (HCC) is increasingly reported in patients with nonalcoholic fatty liver disease (NAFLD). Our aim was to assess the prevalence and mortality of patients with NAFLD-HCC. We examined Surveillance, Epidemiology and End Results (SEER) registries (2004)(2005)(2006)(2007)(2008)(2009)) with Medicare-linkage files for HCC, which was identified by the International Classification of Diseases for Oncology, third edition codes using topography and morphology codes 8170-8175. Medicare-linked data was used to identify NAFLD, hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic liver disease (ALD), and other liver disease using International Classification of Diseases, Ninth Revision, Clinical Modification codes. NAFLD was also defined by clinical diagnosis (cryptogenic cirrhosis, obese-diabetics with cryptogenic liver disease). A logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of HCC. In addition, adjusted hazard ratios for 1-year mortality were estimated by Cox's proportional hazard regression. A total of 4,929 HCC cases and 14,937 controls without HCC were included. Of the HCC cases, 54.9% were related to HCV, 16.4% to ALD, 14.1% to NAFLD, and 9.5% to HBV. Across the 6-year period (2004 to 2009), the number of NAFLD-HCC showed a 9% annual increase. NAFLD-HCC were older, had shorter survival time, more heart disease, and were more likely to die from their primary liver cancer (all P < 0.0001). Of those who received a transplant after HCC (n 5 488), only 5% were related to NAFLD-HCC. In multivariate analysis, NAFLD increased the risk of 1-year mortality (OR, 1.21; 95% CI: 1.01-1.45). Additionally, older age, lower income, unstaged HCC increased risk of 1-year mortality while receiving a liver transplant (LT), and having localized tumor stage were protective (all P < 0.05). Conclusions: NAFLD is becoming a major cause of HCC in the United States. NAFLD HCC is associated with shorter survival time, more advanced tumor stage, and lower possibility of receiving a LT.

NAFLD—which patients should have hepatocellular carcinoma surveillance?

“…In other published cohorts, NAFLD-HCC tends to present at a more advanced age compared to HCV-HCC rather than an earlier one (4,5,11). In our own consecutive series of 628 patients with HCC in Northern England, where NAFLD is the commonest cause of HCC, the median age for HCV-HCC was 60 years, compared to 71 for HCC-NAFLD (5).…”

“…A number of large registry or cohort studies have subsequently confirmed these observations in the United States (3,4), Europe (5) and the Asia Pacific (6,7). The increasing prevalence of obesity worldwide underpins this global pattern of change, with the predicted higher prevalence of NAFLD in coming years a cause for major concern (8).…”

Pathomorphological analysis of nonalcohoholic and alcoholic steathohepatitis adverse consequences

“…Несмотря на относи-тельную редкость развития ГЦР при НАЖБ и НАСГ, пациенты с НАЖБ-ГЦР в продвинутой стадии рака имеют худший прогноз, чем пациен-ты с ХВГС-ГЦР, что подтверждается более низ-кой годовой выживаемостью больных с момента установления диагноза (61 % больных с ХВГС-ГЦР против 50 % больных с НАЖБ-ГЦР P <0,0001) [40].…”

Nem alkoholos zsírmáj és hepatocellularis carcinoma – 2016

“…A NASH-HCC-s betegek idősebbek voltak, mint a HBV/HCV okozta májrákos betegek (73 vs. 66 év), a diagnózistól átlag 5 hónappal volt rövidebb a túlélé-sük, nagyobb volt az 1 éves mortalitás (61 vs. 50%), a cardiovascularis komorbiditás miatt kevésbé kaphattak agresszív onkoterápiát és kisebb volt az esélyük a transzplantációra. Évente 9%-kal nőtt a NASH-HCC és 13%-kal a HCV-HCC incidenciája [47].…”

“…Ennek kimenetelét jelentősen befolyásolhatja az alapbetegséggel kapcsolatos komorbiditás, például a recipiensek kedvezőtlen cardiovascularis státusza [47,52]. A HCC kezelése multidiszciplináris feladat: igényli hepatológusok, onkológusok, invazív radiológusok, patoló-gusok, molekuláris biológusok, sebészek együttműkö-dését.…”