Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.41
Peer-review started: November 1, 2017
First decision: December 1, 2017
Revised: December 7, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: January 27, 2018
To investigate any changing trends in the etiologies of hepatocellular carcinoma (HCC) in Argentina during the last years.
A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease (NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.
A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers (n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC (37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLD-HCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015 (4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3% (P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups (6.6 ng/mL vs 26 ng/mL; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.
The growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.
Core tip: Despite the increasing incidence of non-alcoholic fatty liver disease (NAFLD) and NAFLD related hepatocellular carcinoma (HCC) in developed countries, information related with the burden of NAFLD-HCC in developing countries as those in South America is lacking. In this multicenter cohort study from Argentina including patients with HCC, while HCV and alcoholic related cirrhosis were the most frequent causes of HCC between 2009 and 2016, NAFLD-HCC had a 6-fold increased during the same period. This changing scenario was observed without precluding any specific etiology of liver disease. NAFLD might become one of the first HCC related causes in the coming decades; an issue to be consider with effective prevention strategies.