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. 2023 Apr 6;28(4):341-350.
doi: 10.1093/oncolo/oyac251.

Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies

Surendra Pal Chaudhary  1 , Stephanie Reyes  2 , Matthew L Chase  3 , Aparna Govindan  4 , Lei Zhao  5 , Jay Luther  6 , Irun Bhan  6 , Emily Bethea  6 , Joseph W Franses  1 , Elizabeth Paige Walsh  1 , Leigh Anne Dageford  7 , Shoko Kimura  7 , Nahel Elias  7 , Heidi Yeh  7 , James Markman  7 , Adel Bozorgzadeh  7 , Kenneth Tanabe  8 , Cristina Ferrone  8 , Andrew X Zhu  9 , Karin Andersson  6 , Michael Thiim  6 , Onofrio Antonio Catalano  10 , Avinash Kambadakone  10 , Parsia A Vagefi  11 , Motaz Qadan  8 , Daniel Pratt  6 , Nikroo Hashemi  12 , Kathleen E Corey  6 , Joseph Misdraji  13 , Lipika Goyal  1 , Jeffrey W Clark  1
Affiliations

Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies

Surendra Pal Chaudhary et al. Oncologist. .

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies.

Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients.

Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant.

Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.

Keywords: NAFLD; NASH; hepatocellular carcinoma; metabolic syndrome; outcome; steatohepatitis.

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Conflict of interest statement

Surendra Pal Chaudhary is a full-time employee at EMD Serono, Inc. Lipika Goyal reports receiving research funding (to institution) from Adaptimmune, Bayer, Eisai, Merck, Macrogenics, Genentech, Novartis, Incyte, Eli Lilly, Loxo Oncology, Relay Therapeutics, QED, Servier, Taiho Oncology, Leap Therapeutics, Bristol Meyers Squibb, and Nucana; she also serves as an advisor/consultant to Alentis Therapeutics, AstraZeneca, Exelixis, Genentech, H3Biomedicine, Kinnate, QED Therapeutics, Servier, Sirtex Medical Ltd., Taiho Oncology, Inc., and TranstheraBio. Jeffrey William Clark reports receiving research funding (to institution) from Eisai, Exelixis, Genentech, Surface Oncology, and Trisalus Life Sciences; he also receives consulting fees from Foundation Medicine. The other authors indicated no financial relationships.

Figures

Figure 1.
Figure 1.
CONSORT Diagram of the study depicting screened and eligible populations, reasons for exclusion, and break down of patients into the NAFLD/NASH and other etiologies cohorts.
Figure 2.
Figure 2.
Recurrence-free survival (RFS) of NAFLD/NASH versus other etiologies cohorts.
Figure 3.
Figure 3.
Overall survival (OS) NAFLD/NASH vs other etiologies cohorts.
See this image and copyright information in PMC

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