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Risk for specific cancers increases based on sex of patients with fatty liver

Nonalcoholic fatty liver disease correlated significantly with the development of hepatocellular carcinoma and colorectal cancer in men and breast cancer in women, especially among those with a high NAFLD fibrosis score and fibrosis-4 score, according to a recently published study.

“These findings suggest that patients with NAFLD require multidisciplinary evaluation with attention given to the development of malignancy,” the researchers wrote. “Further studies are needed to specify which high-risk groups of patients with NAFLD carry a greater risk of developing cancers, including HCC, colorectal cancer, and breast cancer.”

To identify the incidence rates of various cancers in patients with NAFLD and the association between NAFLD and cancer development, the researchers followed 25,947 patients for a median of 7.5 years between Sept. 1 2004, and Dec. 31, 2015. Within the cohort, 8,721 had NAFLD.

Compared with patients without NAFLD, those with NAFLD were older (50 vs. 47 years; P < .001), more often men (71.1% vs. 45.1%; P < .001), smokers (58.4% vs. 38.5%; P < .001), more likely to have diabetes (16.2% vs. 4.4%; P < .001) hypertension (32.3% vs. 16.9%; P < .001), higher levels of fasting glucose (102.8 vs. 93.1 mg/dL; P < .001), total cholesterol (200.7 vs. 187 mg/dL; P < .001), serum alanine aminotransferase (30.7 vs. 17.8 U/L; P < .001) and gamma-glutamyl transferase (36.5 vs. 23.3 U/L; P < .001).

During follow-up, 440 patients with NAFLD and 643 patients without NAFLD developed cancer malignancies. Patients with NAFLD had a significantly higher incidence rate (782.9 per 100,000 person-years; 95% CI, 711.5-859.7) compared with those without NAFLD (592.8 per 100,000 person-years; 95% CI, 547.8-640.4).

Specifically, patients with NAFLD had significantly higher rates of HCC (23.1 vs. 0.9; IRR = 25.09; 95% CI, 3.28-191.83) and colorectal cancer (69.4 vs. 34.1 per 100,000 person-years; IRR = 2.04; 95% CI 1.3-3.19), and breast cancer in women (181.6 vs. 102.5 per 100,000 person-years; IRR = 1.77; 95% CI 1.15-2.74) compared with patients without NAFLD.

Stratified by sex, men with NAFLD had significantly increased rates of HCC (P = .01) and colorectal cancer (P = .006) and women with NAFLD had increased rates of breast cancer (P = .01).

After the researchers adjusted for age and sex, the increased rates of HCC (HR = 15.86; 95% CI, 2.07-121.33) and colorectal cancer in men with NAFLD (HR = 2.13; 95% CI, 1.22-3.74) and breast cancer in women with NAFLD (HR = 1.9; 95% CI, 1.2-3.01) remained significant. Similarly, after adjusting for demographic and metabolic factors, the researchers found that NAFLD significantly correlated with increased rates of HCC (HR = 16.73; 95% CI, 2.09-133.85) and colorectal cancer in men (HR = 2.01; 95% CI, 1.1-3.6) and breast cancer in women (HR = 1.92; 95% CI, 1.15-3.2).

After both univariate and multivariable analyses, patients with NAFLD and a NAFLD fibrosis score (NFS) of 1.455 or higher (adjusted HR = 1.87; 95% CI, 1.54-2.28) or a FIB-4 score of 1.45 or higher (adjusted HR = 1.74; 95% CI, 1.42-2.13) had an greater risk for cancer compared with those with lower scores.

“Although our subjects did not undergo liver biopsy, we found that noninvasive fibrosis scores were associated with the development of all cancers and HCC,” the researchers wrote. “A high NFS and a high FIB-4 score were associated with the development of all cancers. In addition, a high NFS or a high FIB-4 score showed strong association with the development of HCC, which corresponds with the results of previous studies.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.