Published online Mar 8, 2017. doi: 10.4254/wjh.v9.i7.385
Peer-review started: July 13, 2016
First decision: December 13, 2016
Revised: December 20, 2016
Accepted: February 8, 2017
Article in press: February 13, 2017
Published online: March 8, 2017
To identify risk factors associated with hepatocellular carcinoma (HCC), describe tumor characteristics and treatments pursed for a cohort of individuals with nonalcoholic steatohepatitis (NASH) cirrhosis.
We conducted a retrospective case-control study of a well-characterized cohort of patients among five liver transplant centers with NASH cirrhosis with (cases) and without HCC (controls).
Ninety-four cases and 150 controls were included. Cases were significantly more likely to be male than controls (67% vs 45%, P < 0.001) and of older age (61.9 years vs 58 years, P = 0.002). In addition, cases were more likely to have had complications of end stage liver disease (83% vs 71%, P = 0.032). On multivariate analysis, the strongest association with the presence of HCC were male gender (OR 4.3, 95%CI: 1.83-10.3, P = 0.001) and age (OR = 1.082, 95%CI: 1.03-1.13, P = 0.001). Hispanic ethnicity was associated with a decreased prevalence of HCC (OR = 0.3, 95%CI: 0.09-0.994, P = 0.048). HCC was predominantly in the form of a single lesion with regional lymph node(s) and distant metastasis in only 2.6% and 6.3%, respectively. Fifty-nine point three percent of individuals with HCC underwent locoregional therapy and 61.5% underwent liver transplantation for HCC.
Male gender, increased age and non-Hispanic ethnicity are associated with HCC in NASH cirrhosis. NASH cirrhosis associated HCC in this cohort was characterized by early stage disease at diagnosis and treatment with locoregional therapy and transplant.
Core tip: The present paper identifies male gender, increased age and non-Hispanic ethnicity as factors associated with hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis cirrhosis. In this series, HCC in nonalcoholic fatty liver disease cirrhosis was diagnosed at an early stage and treated predominantly with locoregional therapy and liver transplantation.