Fatty liver disease, an emerging etiology of hepatocellular carcinoma in Argentina

Abstract

AIMTo investigate any changing trends in the etiologies of hepatocellular carcinoma (HCC) in Argentina during the last years.METHODSA longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease (NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.RESULTSA total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers (n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC (37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLD-HCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015 (4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3% (P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups (6.6 ng/mL vs 26 ng/mL; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.CONCLUSIONThe growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.

Hepatocellular carcinoma in non-alcoholic fatty liver disease with and without cirrhosis

“…NASH has gained attention in recent years because of its association with HCC [1,3] . It is known that there is a risk of progression to advanced fibrosis in up to 20 percent of patients with this pathology, thus increasing the chance of developing liver cancer [1,[8][9][10][11] . Studies have found that 11.3% of patients with cirrhosis due to NASH developed HCC within 5 years, while in patients with cirrhosis due to alcohol, the rate is 12.5% over the same time frame [1] .…”

Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

“…The predominant reported causes of HCC in different geographic areas around the world have been related with chronic hepatitis C virus (HCV) or hepatitis B virus (HBV) infection and alcoholic liver disease[ 2 - 5 ]. Heterogeneous data regarding epidemiology of HCC in Latin America has been reported[ 6 - 12 ]. While HCV and alcoholic liver disease are the most frequent etiologies of HCC in the region, HBV is a leading cause in some countries, mainly in Brazil.…”

Methylenetetrahydrofolate reductase C677T (Ala&gt;Val, rs1801133 C&gt;T) polymorphism decreases the susceptibility of hepatocellular carcinoma: a meta-analysis involving 12,628 subjects

“…Some major susceptibility factors (e.g. aflatoxin-contaminated food, superabundant drinking, tobacco consumption, chronic virus infection, higher body mass index and Type 2 diabetes) [2][3][4][5][6] may contribute to the development of HCC. Additionally, hereditary factor has also been suggested to affect the susceptibility for the occurrence of HCC.…”