Researchers found nonalcoholic fatty liver disease-associated hepatocellular carcinoma to be common and on the rise in the United States, according to data from a population-based study published in Hepatology.
“Our results indicate that there is an increase in the rate of HCC reported to [the Surveillance, Epidemiology and End Results-Medicare database],” Zobair Younossi, MD, MPH, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research of Inova Health System, and colleagues wrote. “We suspect this increase is not only related to an increase in the prevalence of liver diseases such as NAFLD, but also potentially owing to increased awareness of HCC screening in clinical practice.”
Younossi and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database and Medicare claims files between 2004 and 2009 to identify incidence of HCC and liver disease, including NAFLD, hepatitis B or C virus and alcoholic liver disease (ALD). The final cohort included 4,929 cases of HCC and 14,937 matched controls without HCC.
Of patients with HCC, 54.9% were related to HCV, 16.4% to ALD, 14.1% to NAFLD and 9.5% to HBV. The number of patients with NAFLD-associated HCC increased annually by 9%. The annual increase for HCV-associated HCC was 13%. These patients tended to be older, had shorter survival, were more likely to have heart disease and had a high likelihood of dying from HCC (P < .0001 for all). In addition, male gender was associated with nearly 4 times increased odds of having HCC and NAFLD was associated with an almost 3 times increased odds of having HCC.
“Our data showed that patients with NAFLD-related HCC suffer a worst prognosis than other causes of HCC,” the researchers wrote.
Multivariate analysis showed NAFLD was independently associated with increased risk for mortality within the first year of HCC diagnosis (OR = 1.21; 95% CI, 1.01-1.45), as well as older age, unstaged tumor and end-stage renal disease. On the other hand, receiving a liver transplant and having localized tumor stage were protective against 1-year mortality after HCC diagnosis (P < .05 for all).
The researchers concluded: “These data may help inform clinicians, clinical investigators and policy makers to increase the awareness of the increased risk of HCC in patients with NAFLD. … Future studies on the efficacy, effectiveness and cost effectiveness of HCC screening programs in NAFLD patients should be undertaken.” – by Melinda Stevens
Younossi presented preliminary data on this trial at the International Liver Congress 2015 in Vienna.
Disclosure: Younossi reports consulting for AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline and Intercept Pharmaceuticals. Please see the full study for a list of all other authors’ relevant financial disclosures.