Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors for hepatocellular carcinoma in cirrhosis due to nonalcoholic fatty liver disease: A multicenter, case-control study
Kathleen E Corey, Samer Gawrieh, Andrew S deLemos, Hui Zheng, Andrew E Scanga, Jennifer W Haglund, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Samina Munir, Naga Chalasani, Julia Wattacheril
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States
Samer Gawrieh, Naga Chalasani, Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Andrew S deLemos, Department of Medicine, Division of Gastroenterology, Carolinas Medical Center, Charlotte, NC 28203, United States
Andrew E Scanga, Jennifer W Haglund, Department of Medicine, Division of Gastroenterology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States
Samina Munir, Julia Wattacheril, Department of Medicine, Division of Gastroenterology, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY 10032, United States
Author contributions: Corey KE, Gawrieh S, deLemos AS, Scanga AE, Zheng H and Chalasani N performed study design, data collection and manuscript editing; Zheng H responsible for biostatistical analysis, performed study design, data collection and manuscript editing; Haglund JW, Sanchez J and Danford CJ performed data collection and manuscript editing; Comerford M, Bossi K and Munir S performed data collection; Wattacheril J performed study design, data collection, analysis and manuscript preparation.
Institutional review board statement: This study was approved by the Institutional Review Boards at the respective institutions.
Informed consent statement: Informed consent was waived by all Institutional Review Boards as the data collected was retrospective in nature and risk was considered minimal.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Statistical code and dataset are available from the corresponding author at kcorey@partners.org. Consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
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: Kathleen E Corey, MD, MPH, MMSc, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States. kcorey@partners.org
Telephone: +1-617-7240274 Fax: +1-617-7245997
Received: July 12, 2016
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
AIM
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.
METHODS
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).
RESULTS
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.
CONCLUSION
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.
