Effects of Cirrhosis and Diagnosis Scenario in Metabolic‐Associated Fatty Liver Disease‐Related Hepatocellular Carcinoma

Abstract

Metabolic-associated fatty liver disease (MAFLD) is a major cause of liver-related complications, including hepatocellular carcinoma (HCC). While MAFLD-related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD-related HCC in this setting is limited. Here, we characterize MAFLD-related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD-related HCC. MAFLD was defined based on the presence of race-adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan-Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer-related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD-related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD-related HCC was disappointingly low in a multicenter cohort. (Hepatology Communications 2020;0:1-11). H epatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide. (1,2) The most rapidly growing cause of HCC in developed countries is nonalcoholic fatty liver disease or metabolic-associated fatty liver disease (MAFLD), (3,4) which is projected to become a leading

Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

“…This highlights the importance of increasing compliance to primary HCC surveillance among patients at risk for HCC, to increase the likelihood of such patients being diagnosed before the development of MVI. Unfortunately, compliance to HCC surveillance has been reported to be very poor in the real world, with most HCC patients diagnosed at a late stage (31)(32)(33)(34)(35). A recent nationwide USA study of 82,427 patients with cirrhosis reported that HCC surveillance took place in barely 10% of patients (32).…”

Nonalcoholic Fatty Liver Disease: Current Global Burden

“…112 Unfortunately, due to the low incidence of noncirrhotic NAFLD-related HCC, the current practice guidelines do not recommend routine HCC surveillance for noncirrhotic NAFLD. [113][114][115] Future prospective studies exploring the role of screening in noncirrhotic NAFLD-related HCC are required. Additionally, we need to confirm the applicability of screening protocols in practice guidelines for cirrhotic NAFLD-related HCC to enable early detection and improve the prognosis of this serious complication.…”

High-Sensitive CRP Correlates With the Severity of Liver Steatosis and Fibrosis in Obese Patients With Metabolic Dysfunction Associated Fatty Liver Disease

“…MAFLD encompasses a spectrum of liver conditions ranging from simple steatosis to steatohepatitis, fibrosis, and cirrhosis ( 5 ). The pathogenic process of MAFLD is well−thought−out as a systemic metabolic dysfunction state ( 6 ) and commonly linked to various metabolic disorders, including fibrosis and cirrhosis ( 7 ), liver cancer ( 8 ), obesity ( 9 ), type 2 diabetes (T2DM) ( 10 , 11 ), and even cardiovascular disease ( 12 ). It is worth noting that the clinical management and consequence of MAFLD patients are influenced strongly by the more aggressive phenotypes.…”