Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies. Methods Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients. Results Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant. Conclusions Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.

Pharmacological therapy of metabolic dysfunction-associated steatotic liver disease-driven hepatocellular carcinoma

“…A total of 110 HCC patients had MASLD/MASH, and 150 patients had other etiologies. The median age at diagnosis was lower in the other etiology cohort than in the MASLD/MASH-HCC cohort, with a decreased number of female patients (Pal Chaudhary et al, 2023). The diameter of tumors induced by MASLD/MASH was more commonly >5 cm.…”

“…There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. There was a lower rate of background liver fibrosis, lower aspartate transaminase, lower alanine aminotransferase, and higher platelet counts in the MASLD/MASH cohort (Pal Chaudhary et al, 2023). These findings suggest that patients with MASLD/MASH-HCC more commonly presented with larger HCC tumors and lacked liver fibrosis than those with HCC due to other etiologies.…”

“…Mittal's study uncovered that a poor prognosis in patients with MASLD results from the burden of comorbidities, leading to limited access to more radical treatments, such as hepatic resection or transplantation (Mittal et al, 2015). A recent retrospective study replicated these findings, which compared the clinicopathological characteristics and prognosis of patients undergoing surgical resection in MASLD/MASHassociated HCC and other HCC etiologies (Pal Chaudhary et al, 2023). A total of 110 HCC patients had MASLD/MASH, and 150 patients had other etiologies.…”

Risk factors associated with late hepatocellular carcinoma detection in patients undergoing regular surveillance

“…In addition, NAFLD/NASH-associated HCC is frequently diagnosed at a late-stage, probably because of the decreased screening rates for HCC in this population. [15] On the other hand, Chaudhary et al [17] reported that although patients with surgically resected NAFLD/NASH-related HCC showed a larger tumor size than other etiologies of HCC, it did not result in poorer outcomes. Nevertheless, the prevalence of HCC caused by NASH/NAFLD or alcohol consumption is increasing and is expected to continue to increase.…”

Recent treatments to Hepatocellular Carcinoma Cancer(HCC): update and outlook

“…Prevention strategies for HCC often intertwine with the management of these precursory liver diseases. Antiviral therapies for hepatitis, lifestyle modifications for alcoholic liver disease, and metabolic interventions for fatty liver disease are preventative measures that indirectly reduce the risk of HCC [7]. But even with these preventative measures, HCC has a propensity for late-stage diagnosis, partly because the liver is a remarkably stoic organ, capable of performing its functions even when significantly compromised.…”