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
. 2022 Aug:30:100809.
doi: 10.1016/j.neo.2022.100809. Epub 2022 May 27.

Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and Steatosis or Steatohepatitis

Fausto Petrelli  1 , Michele Manara  2 , Silvia Colombo  3 , Gabriella De Santi  2 , Michele Ghidini  4 , Marco Mariani  2 , Alessandro Iaculli  5 , Emanuele Rausa  6 , Valentina Rampulla  2 , Marcella Arru  2 , Matteo Viti  2 , Veronica Lonati  7 , Antonio Ghidini  8 , Andrea Luciani  7 , Antonio Facciorusso  9
Affiliations

Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and Steatosis or Steatohepatitis

Fausto Petrelli et al. Neoplasia. 2022 Aug.

Abstract

Background and aims: Hepatic steatosis of nonalcoholic etiology (nonalcoholic fatty liver disease; NAFLD) is an emergent condition that may lead to hepatic cirrhosis and finally to liver cancer. We evaluate the risk of developing hepatocellular carcinoma (HCC) and quantify the prognosis in terms of recurrence (DFS) as well as HCC-specific and overall survival (CSS and OS) of patients with and without NAFLD.

Methods: We searched published articles that evaluated the risk and outcomes of HCC in patients with steatosis/steatohepatitis from inception to July 2021 were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Prospective cohort, case-control, or retrospective studies were selected that were published in English and provided incidence and survival rates of HCC patients with NAFLD. A random-effects model was created to estimate the pooled effect size. The primary outcome of interest was HCC incidence. The secondary endpoints were DFS, CSS, and OS.

Results: In total, 948 217 patients with NAFLD were analyzed, from n = 103 observational studies. NAFLD significantly increased the risk of HCC (HR = 1.88 [95% CI, 1.46-2.42]; P < .01] but not risk of recurrence (HR = 0.99 [95% CI, 0.85-1.15]; P = .9) or overall mortality (HR = 1.04 [95% CI, 0.88-1.24]; P = 0.64). Conversely, NAFLD increased HCC-related mortality risk (HR = 2.16 [95% CI, 0.85-5.5]; P = .1). Risk of HCC was increased in Western countries but not in Asian countries.

Conclusions: Patients with NAFLD have an increased risk of HCC as compared to patients without NAFLD. NAFLD also increases liver cancer (HCC) mortality. These results justify applying general measures to patients with proven NAFLD and monitoring patients with NASH and fibrosis.

Keywords: Hepatocellular carcinoma; Meta-analysis; NASH; Nonalcoholic fatty liver disease; Steatosis.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest None to declare

Figures

Fig 1
Fig. 1
flow diagram of included studies.
Fig 2
Fig. 2
risk of HCC in patients with NAFLD.
Fig 3
Fig. 3
DFS in patients with HCC and NAFLD.
Fig 4
Fig. 4
CSM in patients with HCC and NAFLD.
Fig 5
Fig. 5
OS in patients with HCC and NAFLD.
See this image and copyright information in PMC

References

    1. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 doi: 10.1002/hep.29367. - DOI - PubMed
    1. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 doi: 10.1002/hep.28431. - DOI - PubMed
    1. Zhou F, Zhou J, Wang W, et al. Unexpected Rapid Increase in the Burden of NAFLD in China From 2008 to 2018: A Systematic Review and Meta-Analysis. Hepatology. 2019 doi: 10.1002/hep.30702. - DOI - PubMed
    1. Orci LA, Sanduzzi-Zamparelli M, Caballol B, et al. Incidence of Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-analysis, and Meta-regression. Clin Gastroenterol Hepatol. 2021 doi: 10.1016/j.cgh.2021.05.002. - DOI - PubMed
    1. Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic Steatohepatitis: A Review. JAMA - J Am Med Assoc. 2020 doi: 10.1001/jama.2020.2298. - DOI - PubMed

Publication types

MeSH terms