Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival-A Retrospective Analysis of a Slovak Cohort.

Dominik Safcak,Svetlana Adamcova-Selcanova,Martin Janicko,Sylvia Drazilova,Marek Rac,Igor Andrasina,Radovan Barila,Jakub Gazda,Miroslav Zigrai,Peter Jarcuska,Michal Mego,Lubomir Skladany

doi:10.3390/jcm10143186

Abstract

Objective: To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system. Methods: We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the period from 2010 through 2016. Results: 12.59% of patients had NAFLD-related HCC, and 21.91% had either NAFLD or cryptogenic etiology. NAFLD-related HCC patients were younger (p = 0.0007), with a higher proportion of women (p < 0.001) compared to other etiology-related HCC patients. The NAFLD group had a significantly lower proportion of patients with liver cirrhosis at the time of HCC diagnosis (p < 0.0001), and they were more frequently diagnosed with both diabetes and metabolic syndrome when compared to other etiology-related HCC (p < 0.0001). We did not find any difference in the overall survival or in the progression-free survival between NAFLD-related and other etiology-related HCC patients staged as BCLC B and BCLC C. NAFLD-related HCC patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions (p = 0.0097), while patients with baseline CRP values of ≥5 mg/L or with PLR ≥ 150 had worse overall survival (p = 0.012 and p = 0.0028, respectively). ALBI Grade 3 predicted worse overall survival compared to ALBI Grade 1 or 2 (p = 0.00021). In NAFLD-related HCC patients, PLR and ALBI remained significant predictors of overall survival even after adjusting for BCLC. Conclusion: NAFLD-related HCC patients have a similar prognosis when compared to other etiology-related HCC. In NAFLD-related HCC patients, ALBI and PLR are significant predictors of the overall survival independent of the BCLC staging system.

Highlights

Primary liver tumors are the sixth most common malignancy worldwide and the third leading cause of cancer-related death [1]
nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions only (p = 0.0097); the overall survival was similar in patients stratified by the diameter of the largest lesion (Figure 5)
platelet-to-lymphocyte ratio (PLR) ≥ 150 and albumin–bilirubin grade (ALBI) Grade 3 were associated with worse overall survival of NAFLD-related HCC patients after adjusting for the Barcelona Clinic Liver Cancer (BCLC) stages (HR = 2.17, 95% CI = 1.04–4.54 and HR = 3.20, 95% CI = 1.18–8.72, respectively) (Table 4)

Summary

Introduction

Primary liver tumors are the sixth most common malignancy worldwide and the third leading cause of cancer-related death [1]. The most common primary liver tumor is hepatocellular carcinoma (HCC). The number of patients with HCC in nonalcoholic fatty liver disease (NAFLD) has been increasing. The presence of metabolic syndrome and type 2 diabetes mellitus may increase the risk of HCC in liver diseases of other etiologies [2]. HCC can arise in a cirrhotic liver, but can arise in NASH without cirrhosis, or even in simple steatosis. 15–50% of HCCs arise in NAFLD patients in a non-cirrhotic liver [4]. The annual incidence of NAFLD-related HCC in Europe and the USA is 0.21–0.6/1000 patients [6,7,8].

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