Abstract
ObjectiveTo recognize risk factors and build up and validate a simple risk model predicting 8‐year cancer events after nonalcoholic fatty liver disease (NAFLD).MethodsThis was a retrospective cohort study. Patients with NAFLD (n = 5561) were randomly divided into groups: training (n = 1254), test (n = 627), evaluation (n = 627), and validation (n = 3053). Risk factors were recognized by statistical method named as a Cox model with Markov chain Monte Carlo (MCMC) simulation. This prediction score was established based on the training group and was further validated based on the testing and evaluation group from January 1, 2007 to December 31, 2009 and another 3053 independent cases from January 1, 2010 to February 13, 2014.ResultsThe main outcomes were NAFLD‐related cancer events, including those of the liver, breast, esophagus, stomach, pancreas, prostate and colon, within 8 years after hospitalization for NAFLD diagnosis. Seven risk factors (age (every 5 years),LDL, smoking, BMI, diabetes, OSAS, and aspartate aminotransferase (every 5 units)) were identified as independent indicators of cancer events. This risk model contained a predictive range of 0.4%‐37.7%, 0.3%‐39.6%, and 0.4%‐39.3% in the training, test, evaluation group, respectively, with a range 0.4%‐30.4% for validation groups. In the training group, 12.6%, 76.9%, and 10.5% of patients, which corresponded to the low ‐, moderate ‐, and high‐risk groups, had probabilities of, <0.01, <0.1, and 0.23 for 8‐year events.ConclusionsSeven risk factors were recognized and a simple risk model were developed and validated to predict the risk of cancer events after NAFLD based on 8 years. This simple risk score system may recognize high‐risk patients and reduce cancer incidence.
Highlights
Nonalcoholic fatty liver disease (NAFLD) has a high prevalence and increasing morbidity in China and other countries.[1,2,3,4] Patients with NAFLD are at high risk of developing cancers, such as primarily hepatocellular carcinoma, colorectal cancer, or breast cancer.[5,6] NAFLD-related cancers have been causing a significant burden for healthcare in China and other countries.[7,8] It has been shown that patients suffering from NAFLD show high potential for cardiovascular diseases and cancer development, which remains the main cause of death among patients with NAFLD.[9]
Seven risk factors were recognized and a simple risk model were developed and validated to predict the risk of cancer events after NAFLD based on 8 years
In the majority of patients, NAFLD is bidirectionally associated with metabolic risk factors, which might represent an important etiology of the increasing morbidity of various solid tumors beyond that of liver cancer.[14,15]
Summary
Seven risk factors were recognized and a simple risk model were developed and validated to predict the risk of cancer events after NAFLD based on 8 years. This simple risk score system may recognize high-risk patients and reduce cancer incidence. KEYWORDS cancers, hepatocellular carcinoma, nonalcoholic fatty liver disease, risk model
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