T1015 Risk Factors for Hepatocellular Carcinoma in Patients with Nonalcoholic Steatohepatitis

Abstract

Background: Hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) has been increasingly reported as the concept of NASH has received wide acceptance among clinicians in the intervening years. Moreover incidence of NASH itself is expected to increase reflecting age of gluttony. However it does not make sense from a cost-effectiveness point of view to screen HCC frequently in all patients with NASH because patients with NASH make up around 1% in overall Japanese population. Aim: This study was designed to assess risk factors for HCC in patients with NASH to develop effective screening methods. Patients and Methods: Our study included all the patients who were consecutively diagnosed at Gunma University Graduate School of Medicine and its affiliated hospitals as having NASH between 2000 and 2006, were followed up for at least 24 months. We evaluated incidence of HCC to date. We compared clinicopathological features (physical findings, laboratory findings, histological features and complications) between patients with HCC (HCC group) and patients without HCC (non-HCC group). The criteria for the diagnosis of NASH were compatible liver histology. We confirmed the diagnosis of HCC by ultrasonographic scanguided tumor biopsy except the treatment-resistant ascites or absence of informed consent in which an angiography or computed tomography showed typical characteristics of HCC. Results: The overall sample included 79 patients (26 men and 53 women, median age 63 years). The follow-up period ranged from 30 to 138 months with an average of 52 months. Fourteen patients (9 men and 5 women, median age 63 years) developed HCC. As for histological stage due to Blunt's classification, 1 and 16 had stage 1, 2 and 23 had stage 2, 3 and 12 had stage 3, and 8 and 14 had stage 4 in HCC group and non-HCC group, respectively. All cases accompanied either obesity or diabetes mellitus. Univariate analysis showed age, sex, histological stage, prothrombin time, serum total cholesterol level, and serum uremic acid level were significant different between HCC group and non-HCC group. Multiple logistic analysis showed male sex (odds ratio: 44.09, 95% Confidence interval: 3.564-545.4, p=0.032) and elder age (odds ratio: 1.134, 95% Confidence interval: 1.0181.265, p=0.029) were significant risk factors for HCC in patients with NASH. Conclusions: Though preliminary results, male sex and elder age were significant risk factors for HCC in patients with NASH and these patients have to be regularly monitored for early detection of HCC. At the same time, we should increase the sample size and follow-up periods and confirm our hypothesis in the near future.