Author information
1 Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
2 Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
3 Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
4 Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND AND AIMS:
Nonalcoholic fatty liver disease (NAFLD) is a growing cause of hepatocellular carcinoma (HCC). In NAFLD, HCC occurs more commonly in the absence of cirrhosis compared with other liverdiseases; yet, patients with non-cirrhotic NAFLD-HCC are poorly characterized. Here, we characterized a large cohort of HCC cases and assessed the outcomes of patients with non-cirrhotic NAFLD-HCC.
METHODS:
We identified all cases of HCC treated at the Karolinska University Hospital, Stockholm, Sweden from 2004-2017. Patient charts were manually reviewed for variable extraction. Cases were followed passively for all-cause and HCC-related mortality until the end of April 2018. Cox regression was performed to estimate mortality rates and identify mortality risk factors in patients with non-cirrhotic NAFLD-HCC.
RESULTS:
Totally, 1562 cases with HCC were identified. Of these, 225 (14.4%) had NAFLD-HCC, of which 83 (37%) did not have cirrhosis. Compared with patients with cirrhotic NAFLD-HCC, patients with non-cirrhotic NAFLD-HCC were older (74 vs. 70 years, p<0.001), had a lower prevalence of type 2 diabetes (T2DM) (66% vs. 80%, p=0.02), larger tumors, less frequently underwent liver transplantation (0% vs. 11%, p=0.002), but more frequently underwent resection (35% vs. 8%, p<0.001). Mortality was similar (aHR for non-cirrhotic NAFLD-HCC vs. cirrhotic NAFLD-HCC 0.93, 95%CI 0.58-1.51, p=0.78). Parameters independently associated with increased mortality included the Barcelona Clinic Liver Cancer stage, number of tumors, lower albumin, and presence of T2DM.
CONCLUSIONS:
Patients with non-cirrhotic NAFLD-HCC differ from those with cirrhosis in age, tumor size, and allocated treatments. Despite these differences, survival is similar.