The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis

Abstract

Nonalcoholic steatohepatitis (NASH) is a well-recognized cause of cirrhosis and has been increasingly associated with the development of hepatocellular carcinoma (HCC). The aims of this study were to (1) estimate the incidence of HCC in patients with NASHrelated cirrhosis, (2) compare incidence in NASH-related cirrhosis with hepatitis C virus (HCV)-related cirrhosis, and (3) identify risk factors of HCC in patients with NASHrelated cirrhosis compared with HCV-related cirrhosis. Adult patients with cirrhosis secondary to chronic HCV (n 5 315) or NASH (n 5 195) were evaluated at our hepatobiliary clinic between 2003 and 2007. To assess for HCC development, all patients were monitored using serial abdominal computed tomography and serum alpha-fetoprotein every 6 months. Kaplan-Meier analysis was performed to estimate the cumulative incidence of HCC. Descriptive statistics were computed for all factors. Univariate and multivariate Cox regression analysis were used to assess associations between HCC and factors of interest. The median follow-up was 3.2 years (25th percentile [P25], 75th percentile [P75]: 1.7, 5.7) during which 25/195 (12.8%) of NASH-cirrhotic and 64/315 (20.3 %) of HCV-cirrhotic patients developed HCC (P 5 0.03). Yearly cumulative incidence of HCC was found to be 2.6% in patients with NASH-cirrhosis, compared with 4.0% in patients with HCV cirrhosis (P 5 0.09). Multivariate regression analysis revealed that older age (P 5 0.006) and alcohol consumption (P 5 0.002) were independent variables associated with development of HCC in patients with NASH-cirrhosis. Compared with nondrinkers, patients who reported any regular alcohol consumption were at greater risk for HCC development (hazard ratio: 3.6; P25, P75: 1.5, 8.3). Conclusion: Patients with NASH cirrhosis have a greatly increased risk of liver cancer. Alcohol consumption, a modifiable risk factor, appears to be the most significant factor associated with risk of HCC development in our study population. (HEPATOLOGY 2010;51:1972-1978

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…4,7,46,47 Patients with NAFLD are at increased risk for HCC, but this risk is likely limited to those with advanced fibrosis and cirrhosis. [48][49][50][51][52][53] Several studies investigated the natural history of NASH cirrhosis in comparison to patients with hepatitis C cirrhosis. [54][55][56][57] One large prospective US-based study 55 observed a lower rate of decompensation and mortality in patients with NASH cirrhosis as compared to patients with hepatitis C cirrhosis.…”

Supplementation of Branched-Chain Amino Acids Maintains the Serum Albumin Level in the Course of Hepatocellular Carcinoma Recurrence

“…To demonstrate this possibility, we need to perform a large scale, randomized, controlled trial in a well-characterized group of patients with appropriate nutritional evaluation and determine the effects of maintaining the Alb level in a longitudinal follow-up. Furthermore, carcinogenesis from nonalcoholic steatohepatitis (NASH) has been increasing, recently (Ascha et al 2010). The weight, plasma BCAA and serum Alb in NASH patients were significantly higher than those in patients with other types of chronic hepatitis (Kakazu et al 2013).…”

Non-alcoholic Fatty Liver Disease: East Versus West

“…Also, older patients are more likely to have advanced fibrosis, cirrhosis, and HCC. 45,46 Whether this is due to longer duration of disease or actually more virulent disease in elderly is not clear. A study from China did not find a worse outcome for older patients.…”