Clinicopathological investigation of steatohepatitic hepatocellular carcinoma: A multicenter study using immunohistochemical analysis of adenoma‐related markers

Background and Aim The prevalence of hepatocellular carcinoma (HCC) associated with nonalcoholic fatty liver disease (NAFLD‐HCC) is increasing. Unfortunately, NAFLD frequently develops into HCC without liver cirrhosis. Therefore, we investigated the clinical features of HCC in NAFLD patients without advanced fibrosis. Methods We compared clinical characteristics, survival rates, and recurrence rates between 104 NAFLD‐HCC patients diagnosed between January 2000 and December 2016, including 35 without (F0–2) and 69 with advanced fibrosis (F3–F4). Risk factors associated with survival and recurrence were evaluated. Results In total, 66.3% of those diagnosed had advanced fibrosis, 58.8% in men and 80.5% in women (men vs women, P = 0.03). In NAFLD‐HCC without advanced fibrosis, tumor size was significantly larger and liver histological activity was lower than those in patients with advanced fibrosis. Survival rates between the two groups did not differ. Among those achieving curative treatment, the recurrence rate was significantly lower in NAFLD‐HCC without advanced fibrosis (P < 0.01). Risk factors of recurrence were male gender, lower serum albumin, and advanced fibrosis. Conclusions In men, HCC tended to develop from NAFLD without advanced fibrosis. Although tumor size in NAFLD‐HCC without advanced fibrosis is significantly larger, the recurrence rate is significantly lower. Surgical therapy should be strongly considered in these cases.

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“…One possibility is steatohepatitic HCC (SH‐HCC). Taniai et al . reported that SH‐HCC was strongly associated with metabolic syndrome and NAFLD.…”

Section: Discussionmentioning

confidence: 99%

“…One possibility is steatohepatitic HCC (SH-HCC). Taniai et al 15 reported that SH-HCC was strongly associated with metabolic syndrome and NAFLD. The characteristic features of SH-HCC compared with non SH-HCC are the development of non-cirrhotic liver and larger main tumors with no difference in the rates of solitary tumor.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of hepatocellular carcinoma in nonalcoholic fatty liver disease patients without advanced fibrosis

Kodama

Kawaguchi

Hyogo

et al. 2019

J of Gastro and Hepatol

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“…There has been an increase of reports about HCC in patients with NAFLD/NASH. 37 - 48 As with other liver diseases, the most important risk factors for HCC are cirrhosis, age and male sex. In addition, obesity, type 2 diabetes, and PNPLA3 increase the risk of HCC.…”

Section: Epidemiologymentioning

confidence: 99%

Characteristic Features of Nonalcoholic Fatty Liver Disease in Japan with a Focus on the Roles of Age, Sex and Body Mass Index

Tobari

Hashimoto

2020

Gut and Liver

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This review provides an update on the characteristics of nonalcoholic fatty liver disease (NAFLD), with a focus on the effects of age, sex, and body mass index. Age is a risk factor for NAFLD progression; however, extremely old patients have unique features, namely, the associations between metabolic comorbidities and NAFLD are weaker and NAFLD is not a risk factor for mortality. The prevalence of NAFLD is higher in men than in premenopausal women, whereas the reverse is true after menopause. Thus, before menopause, estrogen may have protective effects against NAFLD. Our hospital data showed that over 25% of male patients with NAFLD and almost 40% of female patients with NAFLD, especially elderly patients, were nonobese. Although histological steatosis and activity were associated with body mass index, the prevalence of nonalcoholic steatohepatitis was not. The prevalence of advanced fibrosis showed a significant sex difference. Advanced fibrosis was significantly more frequent among severely obese men but the prevalence was lower among severely obese women. This difference could be because a substantial proportion of severely obese women were premenopausal; thus, estrogen may have much stronger effects on the development of fibrosis than on obesity. Further studies are required to develop tailored management strategies.

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“…On the immunohistochemical phenotype, C reactive protein (CRP) expression was frequent [8] . Immunohistochemical expression of serum amyloid A and CRP was significantly higher in this subtype than conventional HCC as revealed by another study [16] . It was also found that the cancer-associated fibroblasts in SH-HCC more frequently expressed senescence-associated secretory phenotype by immunohistochemical staining [14] .…”

Section: Sh-hccmentioning

confidence: 57%

An update on the histological subtypes of hepatocellular carcinoma

Lo¹

2019

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Hepatocellular carcinoma (HCC) is one of the top-ranking cancers worldwide and in Southeast Asia. The high propensity for tumor recurrence, distant metastasis and chemoresistance remain major hurdles in the treatment of HCC. With advances on genetics and genomics research, molecular targeted therapies are emerging as a hope for better disease control. On the histological perspective, microscopic review of clinical samples has led to subclassification of HCC and establishment of new entities. In this review, latest understanding on macrotrabecular-massive HCC, steatohepatitic HCC, lymphocyte-rich HCC, scirrhous HCC, fibrolamellar carcinoma and combined hepatocellular-cholangiocarcinoma will be discussed, emphasizing on the clinical relevance of these pathological entities. Further delineation of the histological, immunohistochemical, molecular and biological phenotypes of primary liver cancer would to further enhance an integrated morphological-molecular classification that better predicts clinical outcome and guides clinical management.

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Clinicopathological investigation of steatohepatitic hepatocellular carcinoma: A multicenter study using immunohistochemical analysis of adenoma‐related markers

Cited by 33 publications

References 40 publications

Clinical features of hepatocellular carcinoma in nonalcoholic fatty liver disease patients without advanced fibrosis

Clinical features of hepatocellular carcinoma in nonalcoholic fatty liver disease patients without advanced fibrosis

Characteristic Features of Nonalcoholic Fatty Liver Disease in Japan with a Focus on the Roles of Age, Sex and Body Mass Index

An update on the histological subtypes of hepatocellular carcinoma

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