Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study

Abstract

Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolte to hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. Aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC), and to compare them to those of HCV-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in Secondary Care Italian Centers. Survival was modeled according to clinical parameters, lead time bias and propensity analysis. As compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC, differently from the near totality of HCV-HCC. Regardless of the tumor stage, the survival was significantly shorter (p=0.017) in patients with NAFLD-HCC, namely 25.5 months (95% CI 21.9-29.1) than with HCV-HCC, 33.7 months (95% CI 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, the analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively 38.6 vs 41.0 months, p=n.s.) Conclusions: NAFLD-HCC and is more often detected at a later tumor stage and could arise also in the absence of cirrhosis. However after patient matching, NAFLD-HCC has a similar survival as compared to HCV-infected patients. Future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment.