Survival after treatment with curative intent for hepatocellular carcinoma among patients with vs without non‐alcoholic fatty liver disease

Summary Background Limited data exist on the burden and features of non‐cirrhotic hepatocellular carcinoma (HCC) in the United States. Aim To evaluate characteristics, aetiologies, trends and outcomes of non‐cirrhotic HCC from 2000 to 2014 at five large US centres Methods Patient, tumour and liver disease aetiology data were collected. The presence of underlying cirrhosis was assessed based on published criteria. Results Of 5144 eligible patients with HCC, 11.7% had no underlying cirrhosis. Non‐cirrhotic patients were older (64.1 vs 61.2 years), more frequently females (33.9% vs 20.8%) and less frequently black (8.3% vs 12.4%) (P < .001 for all). Among non‐cirrhotic patients, non‐alcoholic fatty liver disease (NAFLD) was the most common liver disease (26.3%), followed by hepatitis C virus (HCV) (12.1%) and hepatitis B virus (HBV) (10%) infections. As of 2014, there was increased percentage of cirrhotic HCC and a decline in non‐cirrhotic HCC mainly due to significant annual increases in cirrhotic HCC due to HCV (0.96% [P < .0001]) and NAFLD (0.66% [P = .003]). Patients with non‐cirrhotic HCC had larger tumours (8.9 vs 5.3 cm), were less frequently within Milan criteria (15% vs 39%), more frequently underwent resection (43.6% vs 8%) (P < .001 for all) and had better overall survival than cirrhotic HCC patients (median 1.8 vs 1.3 years, P = .004). Conclusions Nearly 12% of HCCs occurred in patients without underlying cirrhosis. NAFLD was the most common liver disease in these patients. During the study, the frequency of non‐cirrhotic HCC decreased, whereas that of cirrhotic HCC increased. Although non‐cirrhotic patients presented with more advanced HCC, their survival was better.

Section: Discussionsupporting

confidence: 87%

Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study

Gawrieh

Dakhoul

Miller

et al. 2019

“…This important finding suggests a need to reframe our understanding of the NASH‐HCC association to ensure that effective surveillance measures are instituted. The poorer outcomes both pre‐ and post‐transplantation in this patient population, where tumours are often discovered at a more advanced stage with larger volume and greater degrees of infiltration and in the presence of diabetes and obesity, only further underscores the need for improved HCC screening. Consequently, outcomes for NASH‐associated HCC are, in general, inferior to other aetiologies of liver disease as lower survival rates and higher 1‐year mortality rates after diagnosis of HCC have been reported .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the majority of NASH patients with HCC die from their primary liver cancer rather than from cardiovascular disease, and rates of HCC‐related mortality are greatest in the NASH population . On the other hand, survival rates for surgical resection in patients with NASH and HCC are similar to other liver diseases, particularly in the absence of cirrhosis, albeit in highly selected surgical candidates …”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: risk of hepatocellular carcinoma in non‐alcoholic steatohepatitis without cirrhosis compared to other liver diseases

Stine

Wentworth

Zimmet

et al. 2018

246

196

“…Furthermore, the complications recorded in this study were those observed when patients were admitted to clinics. The prolonged enrolment period and a major hepatitis B virus infection in our study could be additional sources of bias since survival varied among HCC patients with different aetiologies …”

Section: Discussionmentioning

confidence: 99%

Microwave vs radiofrequency ablation for hepatocellular carcinoma within the Milan criteria: a propensity score analysis

Liu

Zheng

et al. 2018