Patients with hepatocellular carcinoma and a background of nonalcoholic steatohepatitis may be more likely to survive after curative treatment than patients with carcinomas arising from hepatitis C and/or alcoholic liver disease, according to recent data.
In a retrospective study, researchers evaluated 52 patients with hepatocellular carcinoma (HCC) resulting from nonalcoholic steatohepatitis (NASH) and 162 with HCC arising from HCV and/or alcoholic liver disease (ALD). All patients underwent treatment between 2000 and 2010 at the University of Pittsburgh Thomas E. Starzl Transplantation Institute. Treatments administered included liver transplantation, hepatic resection and radiofrequency ablation.
Investigators found that patients with a NASH background were more likely to be older at HCC diagnosis than patients in the HCV/ALD group (median age 65 years vs. 58 years, P<.05), and also were significantly more likely to be female (48.1% vs. 16.7%, P<.05). The median MELD score was slightly lower in the NASH group than in the HCV/ALD group (9 vs. 10, P<.05), and hepatic bridging fibrosis and cirrhosis were significantly less common in the NASH group (73.1% compared with 93.8%, P<.001).
Ninety-three patients across both groups (43.5%) died during a median follow-up of 50 months, with the most common causes including hepatic failure (51.6%) and HCC progression (32.3%). No significant difference in recurrence-free survival (RFS) rate was found between the two groups (P=.303), but patients in the NASH group had a significantly longer overall survival (OS) rate (median not reached vs. 52 months, P=.009). Through multivariable analysis, liver transplantation and primary T3-4 stage were independently associated with RFS, while liver transplantation, NASH, and albumin levels less than 3.5 mg/dL and alpha-fetoprotein levels greater than 100 ng/mL at HCC diagnosis were associated with OS.
“NASH patients with HCC have less-severe liver dysfunction at HCC diagnosis and better OS after curative treatment compared to counterparts with HCV and/or ALD,” the researchers concluded. “Though our study is one of the largest evaluating long-term outcomes after curative therapy of HCC in NASH, the numbers of patients in each sub-group were relatively small … A similar, multi-institutional evaluation would be beneficial in confirming our findings of prolonged survival among NASH patients.”