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NAFLD-related HCC increasing in US, expected to continue
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VIENNA — As non-alcoholic fatty liver disease reaches ‘epidemic’ status, its relation to hepatocellular carcinoma is also on the rise with a higher rate of mortality among those patients with fatty liver-related carcinoma, according to a study presented at the 2015 International Liver Congress.
“The incidence of HCC in the U.S. is rising. NAFLD is associated with an increased risk of HCC,” Zobair Younossi, MD, MPH, chairman of the department of medicine , Inova Fairfax Hospital, and vice president for research of Inova Health System, said during his presentation. “Given the epidemic of NAFLD in the United States and the rest of the world, the burden of NAFLD-related complications including HCC are expected to rise.”
Zobair Younossi
Younossi and colleagues used the Surveillance, Epidemiology, and End Results database and Medicare claims files to identify incidence of HCC, incidence of liver disease, including NAFLD, hepatitis C virus, hepatitis B virus, alcoholic liver disease, and to obtain a non-HCC control group. The final cohort included 5,748 cases of HCC and 17,244 non-HCC matched controls.
In the HCC group, reasons for HCC were determined to be 48% HCV, 26% NAFLD, 14% alcoholic liver disease, 8% HBV and 4% autoimmune hepatitis or biliary cirrhosis. Since 2004, Younossi showed that NAFLD-related HCC comprises a similar proportion of HCC as compared to viral hepatitis-related HCC and “they are all increasing.”
“Diagnosis of NAFLD-related HCC is associated with a shorter survival time and NAFLD-associated HCC is associated with increased mortality,” Younossi said.
When comparing the two groups, those with NAFLD-related HCC were older at the time of diagnosis (72 ± 10 years vs. 66 ± 11 years; P < .05); more likely to be white (P < .05); more likely to have unstaged or advanced tumors (P < .05); and had approximately 4 months less survival time (P < .05). To the point of mortality, Younossi showed that approximately 50% of patients with HCV/HBV-related HCC died within 1 year of diagnosis while the same was true for 62% of patients with NAFLD-related HCC (P < .05).
While he pointed out that many of the predictive factors of HCC 1-year mortality are expected — older age, lower income, unstaged tumor, disability or end-stage renal disease — NAFLD was independently associated with mortality (HR = 1.21; 95% CI, 1.01-1.45). Likewise, liver transplant was a protective factor against 1-year mortality (HR = 0.13; 95% CI, 0.09-0.17). – by Katrina Altersitz
For More Information:
Younossi Z. Abstract O041. Presented at: International Liver Congress; April 22-26, 2015; Vienna.
Disclosure: Younossi reports serving as a consultant for AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Intercept Pharmaceuticals and Salix.