Comparisons between non-alcoholic steatohepatitis and alcohol-related hepatocellular carcinoma

Abstract

Background/aims: Non-alcoholic liver disease and alcoholic liver disease begin as simple steatosis that may progress to steatohepatitis and ensuing liver-related complications such as cirrhosis and hepatocellular carcinoma (HCC). We explored differences in characteristics between non-alcoholic steatohepatitis (NASH) and alcoholic steatohepatitis-related (ASH) HCC.

Methods: NASH and ASH patients were identified from our department's prospective HCC database. A total of 54 and 45 patients met predefined inclusion and exclusion criteria for the NASH-HCC and ASH-HCC groups, respectively. Clinical, biochemical and tumor characteristics were studied.

Results: NASH-HCC patients were older compared to ASH-HCC patients (72±9 vs. 66±9 years, P<0.001) and less male predominant (65% vs. 98%, P<0.001). Prevalence of diabetes mellitus (78% vs. 36%, P<0.001) and hypertension (80% vs. 58%, P<0.001) were significantly higher in the NASH-HCC group. Liver function tests and Child-Pugh scores were similar. There were no differences in alpha-fetoprotein level, lesions found at diagnosis (unifocal/multifocal) or prevalence of portal vein invasion. In both groups, almost half of the patients were in TNM stage 4 at the time of diagnosis and more than 50% of patients were not suitable for any therapy. Median survival in the NASH-HCC and ASH-HCC groups were 13 and 7 months respectively (P=0.113).

Conclusion: Despite significant differences in demography of the NASH-HCC and ASH-HCC groups, liver and tumor characteristics were comparable. Most patients were diagnosed late and were not amenable to curative or locoregional therapies. Better characterization of patients with NASH and ASH at risk of HCC is necessary to optimize screening, surveillance, and management strategies.

Keywords: Carcinoma, Hepatocellular; Fatty liver, Alcoholic; Non-alcoholic fatty liver disease; Survival.

Figure 1.

Patient selection flowsheet. HCC, hepatocellular carcinoma; HCV, hepatitis C virus; EIA, enzyme linked immunosorbant assay; PBC, primary biliary cirrosis; AIH, autoimmune hepatitis; ASH, alcoholic steatohepatitis; NASH, non-alcoholic steatohepatitis.

Figure 2.

Kaplan Meier overall survival analysis between the NASH-HCC and ASH-HCC groups. NASH, non-alcoholic steatohepatitis; HCC, hepatocellular carcinoma; ASH, alcoholic steatohepatitis.

Figure 3.

Kaplan Meier survival curve: liver-related mortality. NASH, non-alcoholic steatohepatitis; HCC, hepatocellular carcinoma; ASH, alcoholic steatohepatitis.