Introduction Hepatocellular carcinoma (HCC) is the most common primary liver tumour, and represents the third leading cause of cancer death worldwide.1,2 The most important risk factor is liver cirrhosis, mainly due to chronic infections such as hepatitis B or C.2 Increasing HCC cases are seen in nonalcoholic fatty liver disease (NAFLD).
Methods The aim of the study was to compare demographics, treatments and survival among hepatitis C virus (HCV/HCC) and NAFLD (NAFLD/HCC) cohort of patients. Data were collected from medical electronic case notes, imaging reports and HCC multidisciplinary meetings.
Results Among 292 patients, 212 patients (73%) had underlying HCV/HCC and 80 patients (27%) had NAFLD/HCC. The median age at diagnosis was significantly higher in NAFLD/HCC (p < 0.001). The majority (82%) were male. Body mass index (BMI) was significantly higher in NAFLD/HCC (p < 0.001). The majority were Caucasian (96%) in NAFLD/HCC, whilst the HCV/HCC cohort was significantly more ethnically diverse (p < 0.001). Diabetes mellitus was more common in NAFLD/HCC patients (p < 0.001).
The median alpha fetoprotein level in HCV/HCC patients were 32.0 compared to 12.0 in NAFLD/HCC (p = 0.085). Patients with HCV/HCC were significantly more likely to be transplanted during the study period than NAFLD/HCC (30% vs. 15%, p = 0.010). Both transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) were significantly more likely to be used as a single treatment in NAFLD patients, compared to HCV patients (p = 0.042, p = 0.021). Sorafenib was used as the only treatment in 6% of HCV/HCC and 3% of NAFLD/HCC cohorts (p = 0.364). Post transplant survival appeared to be worse in HCV-HCC patients compared to NAFLD/HCC, although it did not reach statistical significance (p = 0.081). Overall five year survival rates were similar between the two groups regardless of any treatment therapies (p = 0.424).
Conclusion Despite the NAFLD/HCC being older and with higher metabolic risk factors, a significant proportion could undergo active therapy. Furthermore, patients with NAFLD/HCC selected for transplantation seemed to have better long term outcomes, possibly due to stricter selection for transplantation as well as variations in tumour biology between the two groups.
References 1 Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol 2013;47 Suppl:S2–6
2 Lu T , et al. Prevention of hepatocellular carcinoma in chronic viral hepatitis B and C infection. World J Gastroenterol 2013;19(47):8887–8894
Disclosure of Interest None Declared.
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