Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 913-918
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.913
Association of nonalcoholic fatty liver disease and liver cancer
Perla Oliveira Schulz, Fabio Gonçalves Ferreira, Maria de Fátima Araújo Nascimento, Andrea Vieira, Mauricio Alves Ribeiro, André Ibrahim David, Luiz Arnaldo Szutan
Perla Oliveira Schulz, Andrea Vieira, Gastroenterology Service, Internal Medicine Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil
Maria de Fátima Araújo Nascimento, Pathology Department, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil
André Ibrahim David, GI Transplant Service, Gastroenterology Department, University of São Paulo, São Paulo 01246-903, Brazil
Fabio Gonçalves Ferreira, Mauricio Alves Ribeiro, Luiz Arnaldo Szutan, Department of Surgery, Liver and Portal Hypertension Group, Santa Casa School of Medical Sciences, São Paulo 01277-900, Brazil
Author contributions: Schulz PO performed the research and collected and analyzed the data; Ferreira FG contributed to the design of the study; Nascimento MFA performed the histological analysis; Vieira A, Ribeiro MA, David AI and Szutan LA contributed to the design of the study and analysis of the data; Schulz PO and Ferreira FG wrote the manuscript.
Supported by CAPES-MEC-Brazil - Grant master’s thesis.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabio Gonçalves Ferreira, MD, PhD, Department of Surgery, Liver and Portal Hypertension Group, Santa Casa School of Medical Sciences, R Apinajes, 1060 ap 93, São Paulo 01277-900, Brazil. drfabioferreira@uol.com.br
Telephone: +55-11-992110057 Fax: +55-11-33378164
Received: June 3, 2014
Peer-review started: June 3, 2014
First decision: June 27, 2014
Revised: July 18, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Processing time: 231 Days and 14.1 Hours
Abstract

AIM: To investigate the association between nonalcoholic fatty liver disease (NAFLD) and liver cancer, and NAFLD prevalence in different liver tumors.

METHODS: This is a retrospective study of the clinical, laboratory and histological data of 120 patients diagnosed with primary or secondary hepatic neoplasms and treated at a tertiary center where they underwent hepatic resection and/or liver transplantation, with subsequent evaluation of the explant or liver biopsy. The following criteria were used to exclude patients from the study: a history of alcohol abuse, hepatitis B or C infection, no tumor detected in the liver tissue examined by histological analysis, and the presence of chronic autoimmune hepatitis, hemochromatosis, Wilson’s disease, or hepatoblastoma. The occurrence of NAFLD and the association with its known risk factors were studied. The risk factors considered were diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, body mass index, dyslipidemia, and arterial hypertension. Presence of reticulin fibers in the hepatic neoplasms was assessed by histological analysis using slide-mounted specimens stained with either hematoxylin and eosin or Masson’s trichrome and silver impregnation. Analysis of tumor-free liver parenchyma was carried out to determine the association between NAFLD and its histological grade.

RESULTS: No difference was found in the association of NAFLD with the general population (34.2% and 30.0% respectively, 95%CI: 25.8-43.4). Evaluation by cancer type showed that NAFLD was more prevalent in patients with liver metastasis of colorectal cancer than in patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma (OR = 3.99, 95%CI: 1.78-8.94, P < 0.001 vs OR = 0.60, 95%CI: 0.18-2.01, P = 0.406 and OR = 0.70, 95%CI: 0.18-2.80, P = 0.613, respectively). There was a higher prevalence of liver fibrosis in patients with hepatocellular carcinoma (OR = 3.50, 95%CI: 1.06-11.57, P = 0.032). Evaluation of the relationship between the presence of NAFLD, nonalcoholic steatohepatitis, and liver fibrosis, and their risk factors, showed no significant statistical association for any of the tumors studied.

CONCLUSION: NAFLD is more common in patients with liver metastases caused by colorectal cancer.

Keywords: Hepatocellular carcinoma; Colorectal liver metastases; Intrahepatic cholangiocarcinoma; Liver fibrosis; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis

Core tip: There has not been a study clearly showing a relation between the nonalcoholic steatohepatitis cirrhosis and hepatocellular carcinoma (HCC). Some studies have suggested that the early stage of hepatic steatosis can be a favorable microenvironment for the development of liver metastases of colorectal cancer (LMCC). Others have suggested that hepatic steatosis has a protective role in the development of LMCC. Our analysis of the association of nonalcoholic fatty liver disease (NAFLD) with liver primary and secondary malignancies found a statistically higher prevalence of NAFLD in patients with LMCC, but not in non-cirrhotic HCC patients.