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. 2021 May;25(5):1193-1202.
doi: 10.1007/s11605-020-04628-0. Epub 2020 May 6.

Impact of Type 2 Diabetes on Oncologic Outcomes of Hepatocellular Carcinomas in Non-Cirrhotic, Non-alcoholic Steatohepatitis: a Matched-Pair Analysis

Adrian T Billeter #  1 , Philip C Müller #  2 , Thomas Albrecht  3 , Stephanie Roessler  3 , Moritz Löffler  3 , Anastasia Lemekhova  2 , Arianeb Mehrabi  2 , Beat P Müller-Stich  2 , Katrin Hoffmann  2
Affiliations

Impact of Type 2 Diabetes on Oncologic Outcomes of Hepatocellular Carcinomas in Non-Cirrhotic, Non-alcoholic Steatohepatitis: a Matched-Pair Analysis

Adrian T Billeter et al. J Gastrointest Surg. 2021 May.

Abstract

Background: Non-alcoholic steatohepatitis (NASH) associated hepatocellular carcinomas (NASH-HCC) are increasing. NASH-HCC often develops in the fibrotic liver. Several analyses report conflicting results regarding the outcome of non-cirrhotic NASH-HCC. Furthermore, type 2 diabetes (T2D) is considered a risk factor for poor survival. The aim of this study was to investigate oncological outcomes of non-cirrhotic NASH-HCC and the impact of T2D.

Methods: Patients with non-cirrhotic NASH-HCC with T2D as determined by an expert pathologist conducting histological slide review were matched for risks factors for poor outcome (age, gender, body mass index) with patients with NASH-HCC without T2D. These patients were then matched 1:1 with HCCs of other underlying liver diseases with and without T2D. Oncological outcomes were assessed using Kaplan-Meier curves.

Results: Out of 365 HCCs resected between 2001 and 2017, 34 patients with non-cirrhotic NASH-HCC were selected (17 with T2D, 17 without T2D) and matched with 26 patients with hepatitis-HCC and 28 patients with alcohol-related HCC. Oncological risk factors such as tumor size, resection margin, and vessel invasion were comparable. There was no difference in overall survival (5-year survival 71.3% for NASH-HCC, 60.4% for hepatitis-HCC, 79.9% for alcohol-HCC). NASH-HCC was associated with longer disease-specific survival than hepatitis-HCC (5-year 87.5% vs. 63.7%, p = 0.048), while recurrence-free survival was identical. T2D had no impact on oncological outcomes in either liver disease.

Conclusion: Non-cirrhotic NASH-HCC has outcomes comparable with other underling etiologies. Despite a lack of cirrhosis, patients with non-cirrhotic NASH-HCC have the same risks of HCC recurrence as patients with cirrhotic liver disease of other etiologies.

Keywords: Diabetes; HCC; NAFLD; NASH; Non-cirrhotic HCC; Type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection
Fig. 2
Fig. 2
Kaplan-Meier plots of overall (a), disease-free (b), and recurrence-free survival (c) for NASH, hepatitis, and alcoholic liver disease
Fig. 3
Fig. 3
Kaplan-Meier plots of overall (a), disease-free (c), and recurrence-free survival (e) for patients with NASH and NASH-DM. Overall (b), disease-free (d), and recurrence-free survival (f) for patients with and without type 2 diabetes mellitus are also depicted
See this image and copyright information in PMC

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