NAFLD linked to lower early-stage detection, poorer survival in patients with HCC
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Nonalcoholic fatty liver disease correlated with lower hepatocellular carcinoma surveillance receipt, early-stage detection and poorer survival compared with other HCC etiologies, according to research.
“In a previous analysis of the Surveillance, Epidemiology and End Results (SEER) Medicare database, only 14% of all HCC diagnosed between 2004 and 2009 were attributed to NAFLD,” Mohammad A. Karim, MD, of the department of epidemiology at the University of Texas MD Anderson Cancer Center in Houston, and colleagues wrote in Clinical Gastroenterology and Hepatology. “However, the burden of NAFLD-associated HCC has likely increased more recently, given the steady increase in the burden of NAFLD in the general population, particularly in states with a higher prevalence of obesity.”
With limited data available on NAFLD-associated HCC in a more recent population, Karim and colleagues identified 5,098 HCC patients from the SEER-Medicare database between 2011 and 2015 and used multivariable logistic regression to determine factors correlated with surveillance receipt, early-stage tumor detection and curative treatment.
According to study results, 1,813 HCC patients had NAFLD — the most common etiology in the cohort — which was associated with lower HCC surveillance receipt (adjusted OR = 0.31; 95% CI, 0.23-0.4), lower early-stage HCC detection (aOR = 0.49; 95% CI, 0.4-0.6) and modestly worse overall survival (adjusted HR = 1.2; 95% CI, 1.09 - 1.32), compared with patients with hepatitis C-related HCC.
Investigators also conducted an NAFLD subgroup analysis, which showed that improved overall survival was associated with early-stage HCC, absence of ascites or hepatic encephalopathy, surveillance and curative treatment receipt. In addition, they noted that NAFLD patients with coexisting liver disease had a greater chance to have surveillance, early-stage detection, curative treatment and improved overall survival vs. those without coexisting liver diseases.
“Our study shows that NAFLD is the leading etiology of HCC among Medicare beneficiaries in the United States,” Karim and colleagues concluded. “These results emphasize that HCC risk stratification of noncirrhotic NAFLD and early recognition of cirrhosis among patients with NAFLD will be critical to increase surveillance implementation and earlier detection of HCC, resulting in increased utilization of curative treatment and improved survival.”
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