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. 2015 Mar;13(3):594-601.e1.
doi: 10.1016/j.cgh.2014.08.013. Epub 2014 Aug 19.

Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population

Sahil Mittal  1 , Yvonne H Sada  2 , Hashem B El-Serag  3 , Fasiha Kanwal  3 , Zhigang Duan  2 , Sarah Temple  2 , Sarah B May  2 , Jennifer R Kramer  2 , Peter A Richardson  2 , Jessica A Davila  2
Affiliations

Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population

Sahil Mittal et al. Clin Gastroenterol Hepatol. 2015 Mar.

Abstract

Background & aims: Nonalcoholic fatty liver disease (NAFLD) is a risk factor for hepatocellular carcinoma (HCC). However, no systemic studies from the United States have examined temporal trends, HCC surveillance practices, and outcomes of NAFLD-related HCC.

Methods: We identified a national cohort of 1500 patients who developed HCC from 2005 through 2010 from Veterans Administration (VA) hospitals. We reviewed patients' full VA medical records; NAFLD was diagnosed based on histologic evidence for, or the presence of, the metabolic syndrome in the absence of hepatitis C virus (HCV) infection, hepatitis B, or alcoholic liver disease. We compared annual prevalence values for the main risk factors (NAFLD, alcohol abuse, and HCV), as well a HCC surveillance and outcomes, among HCC patients.

Results: NAFLD was the underlying risk factor for HCC in 120 patients (8.0%); the annual proportion of NAFLD-related HCC remained relatively stable (7.5%-12.0%). In contrast, the proportion of HCC cases associated with HCV increased from 61.0% in 2005 (95% confidence interval, 53.1%-68.9%) to 74.9% in 2010 (95% confidence interval, 69.0%-80.7%). The proportion of HCC cases associated with only alcohol abuse decreased from 21.9% in 2005 to 15.7% in 2010, and the annual proportion of HCC cases associated with hepatitis B remained relatively stable (1.4%-3.5%). A significantly lower proportion of patients with NAFLD-related HCC had cirrhosis (58.3%) compared with patients with alcohol- or HCV-related HCC (72.4% and 85.6%, respectively; P < .05). A significantly higher percentage of patients with NAFLD-related HCC did not receive HCC surveillance in the 3 years before their HCC diagnosis, compared with patients with alcohol- or HCV-associated HCC. A lower proportion of patients with NAFLD-related HCC received HCC-specific treatment (61.5%) than patients with HCV-related HCC (77.5%; P < .01). However, the 1-year survival rate did not differ among patients with HCC related to different risk factors.

Conclusions: NAFLD is the third most common risk factor for HCC in the VA population. The proportion of NAFLD-related HCC was relatively stable from 2005 through 2010. Although patients with NAFLD-related HCC received less HCC surveillance and treatment, a similar proportion survive for 1 year, compared with patients with alcohol-related or HCV-related HCC.

Keywords: Incidence; Liver Cancer; NASH; Time.

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Conflict of interest statement

CONFLICTS OF INTEREST: No conflicts of interest exist for Drs. Mittal, Sada, El-Serag, Kanwal, Ms. Temple, Ms. May, Duan, Kramer, Richardson, and Davila.

Figures

Figure 1
Figure 1
Prevalence of HCC stratified by risk factors (NAFLD, Alcohol abuse, HCV, and HBV) over time.
Figure 2
Figure 2
Kaplan Meier plot showing overall mortality stratified by risk factors (NAFLD, Alcohol abuse and HCV).
See this image and copyright information in PMC

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