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Comparative Study
. 2012 Aug 21;18(31):4145-9.
doi: 10.3748/wjg.v18.i31.4145.

A comparison of survival and pathologic features of non-alcoholic steatohepatitis and hepatitis C virus patients with hepatocellular carcinoma

Roberto Hernandez-Alejandro  1 , Kris P Croome, Martin Drage, Nathalie Sela, Jeremy Parfitt, Natasha Chandok, Paul Marotta, Cheryl Dale, William Wall, Douglas Quan
Affiliations
Comparative Study

A comparison of survival and pathologic features of non-alcoholic steatohepatitis and hepatitis C virus patients with hepatocellular carcinoma

Roberto Hernandez-Alejandro et al. World J Gastroenterol. .

Abstract

Aim: To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis (NASH) patients with hepatocellular carcinoma (HCC) and hepatitic C virus (HCV) patients with HCC (another group in which HCC is commonly seen) undergoing liver transplantation.

Methods: Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-transplant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features (tumour number, cumulative tumour size, vascular invasion and differentiation) were compared between HCV and NASH liver transplant recipients.

Results: A total of 102 patients with NASH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% (17/102). The incidence of HCC in HCV transplant recipients was 22.6% (64/283). Patients with NASH-HCC were statistically older than HCV-HCC patients (P < 0.001). A significantly higher proportion of HCV-HCC patients had vascular invasion (23.4% vs 6.4%, P = 0.002) and poorly differentiated HCC (4.7% vs 0%, P < 0.001) compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver transplantation (P = 0.11).

Conclusion: Patients transplanted for NASH-HCC appear to have less aggressive tumour features compared to those with HCV-HCC, which likely in part accounts for their improved recurrence free survival.

Keywords: Comparison; Hepatitis C virus; Hepatocellular carcinoma; Liver transplant; Non-alcoholic steatohepatitis; Poorly differentiated; Recurrence; Survival; Vascular invasion.

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Figures

Figure 1
Figure 1
Diagnosis in patients undergoing liver transplantation. HCC: Hepatocellular carcinoma; HCV: Hepatitic C virus; NASH: Non-alcoholic steatohepatitis.
Figure 2
Figure 2
Recurrence free survival in non-alcoholic steatohepatitis-hepatocellular carcinoma vs hepatitis c virus-hepatocellular carcinoma groups. HCC: Hepatocellular carcinoma; HCV: Hepatitic C virus; NASH: Non-alcoholic steatohepatitis.
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