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

By Mustafa S. Ascha, I. Hanouneh, R. Lopez, T. Tamimi, Ariel F. Feldstein, N. Zein. Hepatology, 2010

1,248 citations recorded by the source corpus.

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 NASH‐related 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 NASH‐related cirrhosis compared with HCV‐related cirrhosis. Adult patients with cirrhosis secondary to chronic HCV (n = 315) or NASH (n = 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 = 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 = 0.09). Multivariate regression analysis revealed that older age (P = 0.006) and alcohol consumption (P = 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;)

Subfields: Epidemiology, Hepatology

View Paper: https://www.semanticscholar.org/paper/81519c782c83cc4071a0d264cfc4eddfb163b2bf

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Epidemiology

1. Z. Younossi
2. J. Clark
3. Megan H. Bair-Merritt
4. E. Brunt
5. Q. Anstee
6. C. Day
7. J. Lavine
8. N. Chalasani

In Hepatology

1. Z. Younossi
2. J. Clark
3. Megan H. Bair-Merritt
4. A. McCullough
5. E. Brunt
6. C. Day
7. Q. Anstee
8. R. Finn

Citations in the corpus

• Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis (2017, background): “[46,47] It has been noted that the risk for HCC is greater when the cirrhosis is due to viral hepatitis compared to nonviral causes.[48] However, the risk of HCC in patients with cirrhosis”
• Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta‐analysis (2011, methodology): “if data were available, we evaluated the diagnostic accuracy of the following parameters: (1) parenchymal brightness, (2) liver-to-kidney contrast, (3) deep beam attenuation, (4) bright vessel walls, and (5) gallbladder wall definition.”
• Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation (2014, background): “However, consideration should be given to treating those with compensated disease who are awaiting transplant with modified interferon and ribavirin dosing, especially if the genotype is favorable (genotype II, III), the patient has a potential living donor, or MELD exception points for HCC.90 This ”
• Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases (2019, background): “(12) In a study comparing the incidence of HCC among patients with HCV infection and NAFLD,(44) 315 patients with cirrhosis secondary to HCV and 195 with cirrhosis attributed to NAFLD were followed for a median of 3.2 years.”
• ENDPOINTS AND CLINICAL TRIAL DESIGN FOR NONALCOHOLIC STEATOHEPATITIS (2011, background): “There are conflicting reports of the impact of small amounts of alcohol consumption on NASHrelated outcomes.(8,27) Given the possibility that small amounts of alcohol intake may affect outcomes in NAFLD, the amount and pattern of alcohol consumption during the trial should be documented, using estab”
• Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. (2014, background): “For example, Ascha et al.(9) reported an HCC incidence of 2.”
• Hepatocellular carcinoma in non-alcoholic fatty liver disease: an emerging menace. (2012, background): “This has been suggested to occur in cirrhosis associated with both chronic hepatitis C infection and alcoholic liver disease [37,39].”