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Abstract Details
Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies
Oncologist. 2023 Feb 10;oyac251. doi: 10.1093/oncolo/oyac251. Online ahead of print.
1Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA.
2Duke University School of Medicine, Durham, NC, USA.
3Beth Israel Deaconess Hospital, Needham, MA, USA.
4Icahn School of Medicine at Mount Sinai, New York, NY, USA.
5Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
6Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
7Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
8Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
9Jiahui Health, Jiahui International Cancer Center, Shanghai, People's Republic of China.
10Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
11Division of Surgical Transplantation, University of Texas Southwestern, Dallas, TX, USA.
12Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
13Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, USA.
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies.
Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients.
Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant.
Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.