Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;155(6):1828-1837.e2.
doi: 10.1053/j.gastro.2018.08.024. Epub 2018 Aug 23.

Risk of Hepatocellular Cancer in Patients With Non-Alcoholic Fatty Liver Disease

Fasiha Kanwal  1 , Jennifer R Kramer  2 , Srikar Mapakshi  2 , Yamini Natarajan  3 , Maneerat Chayanupatkul  3 , Peter A Richardson  2 , Liang Li  4 , Roxanne Desiderio  2 , Aaron P Thrift  5 , Steven M Asch  6 , Jinna Chu  7 , Hashem B El-Serag  8
Affiliations

Risk of Hepatocellular Cancer in Patients With Non-Alcoholic Fatty Liver Disease

Fasiha Kanwal et al. Gastroenterology. 2018 Dec.

Abstract

Background & aims: There are limited data on the risk of hepatocellular cancer (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). We aimed to estimate the risk of incident HCC among patients with NAFLD.

Methods: We conducted a retrospective cohort study from a total of 130 facilities in the Veterans Health Administration. Patients with NAFLD diagnosed between January 1, 2004 and December 31, 2008 were included and followed until HCC diagnosis, death, or December 31, 2015. We also identified a sex- and age-matched control cohort without NAFLD. We ascertained all new HCC cases from the Central Cancer Registry and manual chart reviews. We calculated incidence rates for HCC by NAFLD status, as well as in subgroups of NAFLD patients. We used competing risk models to compare the risk of HCC in patients with NAFLD vs those without NAFLD. We reviewed electronic medical records of all HCC cases that developed in NAFLD patients without cirrhosis.

Results: We compared 296,707 NAFLD patients with 296,707 matched controls. During 2,382,289 person-years [PYs] of follow-up, 490 NAFLD patients developed HCC (0.21/1000 PYs). HCC incidence was significantly higher among NAFLD patients vs controls (0.02/1000 PYs; hazard ratio, 7.62; 95% confidence interval, 5.76-10.09). Among patients with NAFLD, those with cirrhosis had the highest annual incidence of HCC (10.6/1000 PYs). Among patients with NAFLD cirrhosis, HCC risk ranged from 1.6 to 23.7 per 1000 PYs based on other demographic characteristics; risk of HCC was the highest in older Hispanics with cirrhosis. In medical record reviews, 20% of NAFLD patients with HCC had no evidence of cirrhosis.

Conclusions: Risk of HCC was higher in NAFLD patients than that observed in general clinical population. Most HCC cases in NAFLD developed in patients with cirrhosis. The absolute risk of HCC was higher than the accepted thresholds for HCC surveillance for most patients with NAFLD cirrhosis.

Keywords: Cohort; Hepatitis; Liver Cancer; Outcome.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST: None to report

Figures

Figure 1:
Figure 1:
Cumulative Incidence of hepatocellular cancer in patients with and without nonalcoholic fatty liver disease (NAFLD).
Figure 2:
Figure 2:
Incidence of hepatocellular cancer in different subgroups of non-alcoholic fatty liver disease patients with cirrhosis
See this image and copyright information in PMC

Comment in

  • [Do NAFLD-patients require HCC screening?].
    Karlas T, Wiegand J, Petroff D. Karlas T, et al. Z Gastroenterol. 2019 Feb;57(2):160-161. doi: 10.1055/a-0825-7739. Epub 2019 Feb 12. Z Gastroenterol. 2019. PMID: 30754062 German. No abstract available.

References

    1. Ryerson AB, Eheman CR, Altekruse SF, et al. Annual Report to the Nation on the Status of Cancer, 1975–2012, featuring the increasing incidence of liver cancer. Cancer. 5/1/2016 2016;122(9):1312–1337 - PMC - PubMed
    1. Kaplan DE, Chapko MK, Mehta R, Dai F, Skanderson M, Aytaman A, Baytarian M, D’Addeo K, Fox R, Hunt K, Pocha C, Valderrama A, Taddei TH; VOCAL Study Group. Healthcare Costs Related to Treatment of Hepatocellular Carcinoma Among Veterans With Cirrhosis in the United States. Clin Gastroenterol Hepatol. 2017. July 26 pii: S1542–3565(17)30861–3. doi: 10.1016/j.cgh.2017.07.024. [Epub ahead of print]. PubMed PMID: . - DOI - PMC - PubMed
    1. Yang JD, Larson JJ, Watt KD, Allen AM, Wiesner RH, Gores GJ, Roberts LR, Heimbach JA, Leise MD. Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States. Clin Gastroenterol Hepatol. 2017. May;15(5):767–775. e3. doi: 10.1016/j.cgh.2016.11.034. Epub 2016 Dec 21. PubMed PMID: ; PubMed Central PMCID: PMC5401787 - DOI - PMC - PubMed
    1. Mittal S, Sada YH, El-Serag HB, Kanwal F, Duan Z, Temple S, May SB, Kramer JR, Richardson PA, Davila JA. Temporal trends of nonalcoholic fatty liver diseaserelated hepatocellular carcinoma in the veteran affairs population. Clin Gastroenterol Hepatol. 2015;13(3):594–601 - PMC - PubMed
    1. Adams LA, Lindor KD. Nonalcoholic fatty liver disease. Ann Epidemiol 2007;17(11):863–869 - PubMed

Publication types