Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease

Dahan, Karim Seif El; Daher, Darine; Singal, Amit G.

doi:10.3350/cmh.2022.0247

Cited by 14 publications

(15 citation statements)

References 89 publications

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“…Non‐alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with the estimated prevalence of 25% 1 . Along with the increase in metabolic abnormalities such as obesity, hypertension, diabetes and hyperlipidaemia, the incidence of NAFLD is on the rise worldwide, and the disease progression and related deaths are expected to increase gradually 2–4 . Beyond the well‐known liver‐related morbidity and mortality, NAFLD is associated with an increased risk of fatal and non‐fatal cardiovascular disease (CVD), which is the main cause of death in patients with NAFLD 5–8 .…”

Section: Introductionmentioning

confidence: 99%

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Chun

Lee

et al. 2023

Liver International

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Background and Aims Cardiovascular disease (CVD) is the main cause of mortality in subjects with non‐alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction‐associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk. Methods Subjects who underwent a comprehensive medical check‐up were recruited (2014–2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis‐4 index, aspartate aminotransferase to platelet ratio index, or FibroScan‐aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score > 10%. Results Of the study population (n = 78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p < .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR] = 1.10, p = .038), whereas NAFLD was not (all p > .05). MAFLD (aOR = 1.40) or NAFLD (aOR = 1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p < .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p < .05). Conclusion MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.

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Section: Introductionmentioning

confidence: 99%

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Chun

Lee

et al. 2023

Liver International

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“…24 Considering the increasing burden of NAFLD in the world, 25,26 American Association of Clinical Endocrinology (AACE) and American Association for the Study of Liver Diseases (AASLD) recently provided a clinical practice guideline for diagnosis and management of NAFLD to prevent the development of liver cirrhosis and related comorbidities. 27,28 The guideline suggests using liver fibrosis prediction calculations (e.g., Fibrosis-4 [FIB-4]) to initially assess the risk of advanced liver fibrosis in NAFLD patients, and triage the high-risk patients for fibrosis/cirrhosis screening by transient elastography. With increased availability of non-invasive biomarkers of fibrosis and transient elastography, the guideline will potentially increase recognition of NAFLD-related cirrhosis, especially for primary care physicians and endocrinologists who often look after NAFLD patients.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma

Lee¹,

Karim²,

Kum³

et al. 2023

Clin Mol Hepatol

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Background: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.Methods: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEER-Medicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis.Factors associated with unrecognized cirrhosis were identified using logistic regression analyses.Factors associated with overall survival were evaluated using Cox regression analyses.Results: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83-2.46), non-Hispanic Black race (aOR:1.93, 95%CI: 1.45-2.57), and NAFLD etiology (aOR:4.46, 95% CI:3.68-5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR:2.32, 95% CI:1.71-3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR:1.17, 95% CI:1.08-1.27) compared to recognized cirrhosis. Conclusion: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male andBlack patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes. HIGHLIGHTCirrhosis is the most important risk factor of HCC; however, early cirrhosis is often undiagnosed. We characterized factors associated with unrecognized cirrhosis in a national sample of HCC patients from the United States. Among HCC patients with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR:2.12, 95%CI:1.83-2.46), non-Hispanic Black race (aOR:1.93, 95%CI:1.45-2.57), and NAFLD etiology (aOR:4.46, 95%CI:3.68-5.41) were associated with having unrecognized cirrhosis. Unrecognized cirrhosis was associated with worse survival (aHR:1.17, 95%CI:1.08-1.27) compared to recognized cirrhosis. Our findings suggest these groups as important intervention targets to improve HCC surveillance uptake.

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“…Unlike viral hepatitis, the criteria for the high-risk group of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NASH)-related liver cancer have not yet been defined, and there is a lack of social consensus on how to screen, evaluate, and manage the so-called "high-risk group". 9,10 This indicates that some high-income countries require a national strategy or reasonable screening algorithm for non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NASH)-related liver cancer. Another interesting point is that alcohol-related liver cancer remains an important cause of liver cancer in almost all countries.…”

Section: See Article On Page 433mentioning

confidence: 99%

The latest global burden of liver cancer: A past and present threat

Oh¹,

Jun²

2023

Clin Mol Hepatol

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Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease

Abstract: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding agencies had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript.

Cited by 14 publications

References 89 publications

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma

The latest global burden of liver cancer: A past and present threat

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