NAFLD increases risk for hepatocellular carcinoma
Nonalcoholic fatty liver disease correlated with a significantly increased risk for developing cancer overall, due to the significant increased incidence in hepatocellular carcinoma, according to study results.
“For the first time on a nationwide scale, this study provides quantitative estimates regarding the risks of developing overall and site-specific cancers according to the presence and histological severity of NAFLD,” Tracey G. Simon, MD, from the division of gastroenterology and hepatology, Massachusetts General Hospital in Boston, and colleagues wrote. “We demonstrate that significant excess HCC risk is evident across all stages of NAFLD, and the magnitude of that risk is amplified by comorbid diabetes. Our findings underscore the need for improved, personalized HCC surveillance strategies for high-risk patients with NAFLD.”
Simon and colleagues conducted a population-based study in Sweden of 8,892 patients with histologically defined NAFLD.
“NAFLD was defined from prospectively recorded liver histopathology submitted to all 28 Swedish pathology departments and categorized as simple steatosis, nonfibrotic nonalcoholic steatohepatitis (NASH), noncirrhotic fibrosis, and cirrhosis,” Simon and colleagues wrote.
Investigators matched NAFLD patients by age, sex, calendar year and county to 5 or less general population control participants without NAFLD (n = 39,907).
“Over a median of 13.8 years, we documented 1,691 incident cancers among NAFLD patients and 6,733 among controls,” the researchers wrote. “Compared with controls, NAFLD patients had significantly increased overall cancer incidence (10.9 vs. 13.8/1,000 person‐years [PY]; difference = 2.9/1,000 PY; aHR, 1.27; 95%CI, 1.18‐1.36), driven primarily by HCC (difference = 1.1/1,000 PY; aHR, 17.08; 95%CI, 11.56‐25.25).”
HCC incidence rates increased monotonically in simple steatosis (0.8/1,000 PY), nonfibrotic NASH (1.2/1,000 PY), noncirrhotic fibrosis (2.3/1,000 PY) and cirrhosis (6.2/1,000 PY) (P for trend < .01). Investigators reported diabetes amplified these rates.
NAFLD correlated with a modest increased rate of pancreatic cancer(difference = 0.2/1,000 PY), kidney/bladder cancer (0.1/1,000 PY) and melanoma (0.2/1,000 PYs) but not other cancers, according to Simon and colleagues.