Abstract

Background Nonalcoholic fatty liver disease (NAFLD) may develop into liver cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to compare the clinical patterns and survival outcomes of NAFLD-related HCC patients and those of alcoholic liver disease (ALD)-related or hepatitis B virus (HBV)-related HCC patients. Methods A total of 622 HCC patients with associated NAFLD (n = 56), ALD (n = 173), or HBV infection (n = 393) were enrolled. The clinical characteristics and survival were analyzed according to the underlying liver diseases. Results NAFLD-related HCC patients were more commonly older women and had more metabolic risk factors but were less likely to have cirrhosis and ascites, compared to ALD-related or HBV-related HCC patients. NAFLD-related HCC more often had an infiltrative pattern (P=0.047), a larger tumor (P=0.001), more macrovascular invasion (P=0.022), and exceeded the Milan criteria (P=0.001), but was less frequently diagnosed during tumor surveillance (P=0.025). Survival analysis did not show any difference among NAFLD-related, ALD-related, and HBV-related HCC patients. Furthermore, propensity score matching analysis did not reveal a significant difference in the median survival between the different groups (NAFLD vs. ALD, 14.0 months [95% confidence interval (CI), 2.0–26.0] vs. 13.0 months [95% CI, 0–26.3]; P=0.667, NAFLD vs. HBV, 14.0 months [95% CI, 2.0–26.0] vs. 12.0 months [95% CI, 4.3–17.8]; P=0.573). Conclusions NAFLD-related HCCs were more often detected at an advanced stage with infiltrative patterns, although they showed no significant difference in survival compared to ALD-related or HBV-related HCCs. A future prospective research should be focused on identifying NAFLD patients who require strict surveillance in order to early detect and timely treat HCC.

Highlights

  • Liver cancer is the sixth most common solid tumor with over half a million new cases and the second leading cause of cancer death worldwide [1]

  • 50% of the new cases are owing to the large number of patients with chronic hepatitis C, while chronic hepatitis B and alcoholic liver disease (ALD) were other contributing factors [7, 8]

  • Nonalcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of lipids within the cytoplasm of hepatocytes in people who do not consume alcohol; it encompasses a broad spectrum of features, ranging from simple reversible steatosis to the presence of inflammation and/or fibrosis, which can progress to cirrhosis and hepatocellular carcinoma (HCC) [14]

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Summary

Introduction

Liver cancer is the sixth most common solid tumor with over half a million new cases and the second leading cause of cancer death worldwide [1]. 50% of the new cases are owing to the large number of patients with chronic hepatitis C, while chronic hepatitis B and alcoholic liver disease (ALD) were other contributing factors [7, 8]. E aim of this study was to compare the clinical patterns and survival outcomes of NAFLD-related HCC patients and those of alcoholic liver disease (ALD)-related or hepatitis B virus (HBV)-related HCC patients. Survival analysis did not show any difference among NAFLD-related, ALD-related, and HBV-related HCC patients. NAFLD-related HCCs were more often detected at an advanced stage with infiltrative patterns, they showed no significant difference in survival compared to ALD-related or HBV-related HCCs. A future prospective research should be focused on identifying NAFLD patients who require strict surveillance in order to early detect and timely treat HCC

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