NAFLD may be a common underlying liver disease in patients with hepatocellular Carcinoma in the United States

Abstract

The incidence of hepatocellular carcinoma (HCC) in the United States is increasing, but the clinical characteristics of American patients with HCC have not been well described. The aims of this study were to determine the etiology of liver disease and short-term outcome among HCC patients presenting to a single center in the United States. One hundred five consecutive patients with HCC were studied; mean age was 59 years, 67% were men, and 76% were non-Hispanic white. The most common etiology of liver disease was hepatitis C (51%) and cryptogenic cirrhosis (29%). Half of the patients with cryptogenic cirrhosis had histologic or clinical features associated with nonalcoholic fatty liver disease (NAFLD).Fifty-three (50%) patients had HCC detected during surveillance (group I), whereas the remaining patients had symptomatic tumors (group 11). Group I patients had smaller tumors (P = .Ol), were more likely to be eligible for surgical treatment (P = .005), and had a better median survival compared with patients in group I1 (P = .OO1). Patients with cryptogenic cirrhosis were less likely to have undergone HCC surveillance and had larger tumors at diagnosis. In conclusion, hepatitis C and cryptogenic liver disease are the most common etiologies of diseases in our patients with HCC. NAFLD accounted for at least 13% of the cases. Patients who underwent surveillance had smaller tumors and were more likely to be candidates for surgical or local ablative therapies. Because of the increasing incidence of NAFLD, further studies are needed to determine the risk of HCC in patients with NAFLD.

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

“…These findings support the hypothesis that NASH is a risk factor for HCC and that it may explain a considerable proportion of cryptogenic HCC cases. In these studies, however, the prevalence of cryptogenic HCC was 7% (Bugianesi et al, 2002) and 9% (Regimbeau et al, 2004), much lower than the 29% reported in a USA study with a high prevalence of obesity and obesity-related metabolic disorders (Marrero et al, 2002).…”

Epidemiology of hepatocellular carcinoma in areas of low hepatitis B and hepatitis C endemicity

“…Similarly, the rate for blacks, starting at 2.5 between 1976 and 1978, reached 5.0 for the period of 2000-2002. Finally, the rate among other racial groups (predominantly Asians) started at 6.0 between 1976 and 1978 and subsequently rose but appeared to have reached a (Marrero et al, 2002) (Table 7). HCV was the underlying cause for the liver disease in 51 percent (39 percent had only HCV as a risk factor and another 12 percent also had a history of chronic alcoholism), 29 percent had cryptogenic liver disease, 10 percent had only heavy alcoholism as a potential etiology, 6 percent were infected with HBV and 4 percent were associated with other conditions.…”

“…That HCC was among the most common of cancers worldwide could then be accounted for by the fact that HBV infection, the leading cause for HCC, is endemic in southeast Asia (Beasley et al, 1981), the most populous area in the world, as well as in sub-Saharan Africa. More recently, it has become apparent that obesity, with its accompanying problems of diabetes mellitus and nonalcoholic steatohepatitis (NASH), represents a growing addition to the causes of HCC (Marrero et al, 2002;Caldwell et al, 2004;El-Serag et al, 2004). Furthermore, evidence is accumulating that both diabetes and chronic alcoholism behave synergistically with HBV and HCV infections in the induction of HCC (Hassan et al, 2002).…”

Hypertension and fatty liver: guilty by association?

“…51 Cirrhosis resulting from NAFLD accounts for approximately 13% of all cases of hepatocellular carcinoma. 52 Unrelated to the risk of progressive liver disease in NAFLD, fatty liver can accelerate the progression of other forms of chronic liver disease, in particular hepatitis C. 53,54 Pathogenesis of fatty liver…”