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Veterans with NAFLD-related HCC lacked surveillance before diagnosis

Veterans with hepatocellular carcinoma related to nonalcoholic fatty liver disease underwent surveillance at a lower rate compared with veterans with hepatocellular carcinoma associated with hepatitis C virus or alcohol abuse, according to new study data.

Researchers, including Sahil Mittal, MD, MS, assistant professor at Baylor College of Medicine, analyzed medical records from 1,500 patients (mean age at diagnosis, 63.7 years; 99.8% men) with hepatocellular carcinoma (HCC) from VA hospitals for fiscal-years 2005 to 2010. Eight percent of the cohort had nonalcoholic fatty liver disease (NAFLD); 80.6% showed alcohol abuse; 67.5% had hepatitis C virus (HCV); 4.6% had hepatitis B virus (HBV); and 61.8% displayed more than one risk factor. Most veterans with NAFLD-related HCC were older and white.

Sahil Mittal

The proportion of NAFLD-associated HCC remained consistent (7.5% to 12%) during the study period, however, HCV-related HCC increased from 61% (95% CI, 53.1-68.9) to 74.9% (95% CI, 69%-80.7%).

A greater percentage of patients with NAFLD-related HCC did not undergo HCC surveillance in the 3 years before diagnosis (56.7%) compared with those with alcohol abuse- (40.2%) or HCV-associated HCC (13.3%; P<.01). A larger proportion of patients with NAFLD-related HCC did not receive HCC-specific therapy compared with patients with HCV-related HCC (77.5% vs. 61.5%; P<.01), but the percentage was similar to alcohol abuse-related HCC patients (77.5% vs. 74.5%; P=.69). One-year survival rates were similar among all patients with HCC, regardless of risk factors.

“NAFLD is the third most common cause of HCC after alcohol abuse and HCV in the VA population,” Mittal told Healio.com/Hepatology. “NAFLD patients were less likely to receive surveillance in years prior to diagnosis of HCC. This should prompt clinicians to maintain high index of suspicion given the common perception that NAFLD is a benign and indolent disease combined with absence of reliable serologic markers to diagnose NAFLD.”

Disclosure: The researchers report no relevant financial disclosures.