Increased risk of hepatocellular carcinoma and mortality in chronic viral hepatitis with concurrent fatty liver

Abstract

Summary Background Population‐based data are lacking regarding whether fatty liver is a risk factor for hepatocellular carcinoma (HCC) and mortality in patients with chronic viral hepatitis. Aim To investigate the association of fatty liver with HCC incidence and mortality in patients with chronic viral hepatitis using a nationwide cohort Methods We included 57,385 patients with chronic hepatitis B (CHB) or chronic hepatitis C (CHC) who underwent health examinations. The patients were divided into three groups: no fatty liver, fatty liver index (FLI) <30, grade 1 (G1) fatty liver: 30≤ FLI <60, and grade 2 (G2) fatty liver: FLI >60. Results During a median 8.4‐year follow‐up, we documented 3496 HCC cases and 4146 deaths. Compared to patients with no fatty liver (n = 35,018), the risk of HCC was significantly higher in patients with G1 fatty liver (n = 14,544) (adjusted hazard ratio [aHR] = 1.50, 95% confidence interval [CI] = 1.38‐1.64) and G2 fatty liver (n = 7,823) (aHR = 1.88, 95% CI = 1.67‐2.12). The risk of mortality was significantly higher in patients with G1 fatty liver (aHR = 1.53, 95% CI = 1.41‐1.66) and G2 fatty liver (aHR = 2.16, 95% CI = 1.94‐2.42) compared to patients with no fatty liver. Conclusions Concurrent fatty liver was associated with a higher risk of HCC and mortality in patients with chronic viral hepatitis. Our results suggest the importance of management of fatty liver to reduce the risks of HCC and mortality in patients with chronic viral hepatitis.

Metabolic dysfunction and cancer in HCV: Shared pathways and mutual interactions

“…Accumulation of lipids in the liver, known as steatosis, results from imbalances in hepatic metabolic fluxes 11 ; steatosis is a prominent histological characteristic of CHC occurring in 40% to 80% of patients depending on the prevalence of co-factors (such as alcohol consumption, obesity and MetS) and the HCV genotype 4 . Patients with concurrent CHC and steatosis have an increased risk of HCC development and mortality compared to those with no steatosis 12 .…”

Nonalcoholic fatty liver disease versus metabolic-associated fatty liver disease: Prevalence, outcomes and implications of a change in name

“…38 HCC patients affected by both HBV and MAFLD undergoing curative resection were more likely to have recurrence compared to HCC patients with HBV infection without MAFLD. 39 However, while some studies found that patients with HBV and hepatic steatosis have worse outcomes, 40,41 others have found that the presence of steatosis in HBV was asscociated with lower risk of cirrhosis, hepatocellular carcinoma, and higher chance of hepatitis B surface antigen seroclearance. [42][43][44][45][46][47] Thus, further studies are needed to elucidate the relationship between hepatic steatosis, metabolic derangement, and long-term clinical complications.…”

Clinical impact and mechanisms of hepatitis B virus infection concurrent with non-alcoholic fatty liver disease

“…[ 9 ] Similar results were obtained in a recent study by van Kleef et al [ 79 ] . Additionally, a study by Kim et al [ 80 ] reported that CHB patients with liver steatosis had a higher risk of all-cause mortality and cancer development compared to patients without liver steatosis. Another retrospective study included 524 treatment-naïve patients with CHB with a mean follow-up of 6 years.…”