Survival after treatment with curative intent for hepatocellular carcinoma among patients with vs without non‐alcoholic fatty liver disease

• DOI: 10.1111/apt.14342
• Publication Date: 2017-09-28T16:03:59Z
• Authors: C. R. Wong; B. Njei; M. H. Nguyen; A. Nguyen; J. K. Lim
• Keywords: Adult; Aged, 80 and over; Male; 0301 basic medicine; 0303 health sciences; Carcinoma, Hepatocellular; Liver Neoplasms; Hepatitis C, Chronic; Middle Aged; 3. Good health; Cohort Studies; 03 medical and health sciences; Hepatitis B, Chronic; Liver Cirrhosis, Alcoholic; Non-alcoholic Fatty Liver Disease; Humans; Female; Liver Diseases, Alcoholic; Aged

AbstractBackgroundNon‐alcoholic fatty liver disease (NAFLD) is expected to become a leading aetiology of hepatocellular carcinoma (HCC)‐related mortality in the United States. HCC treatments with curative intent (OLT, orthotopic liver transplantation; resection; RFA, radiofrequency ablation) can improve survival in carefully selected patients.AimTo compare survival after receipt of curative treatment for NAFLD and non‐NAFLD‐HCC aetiologies (HCV, chronic hepatitis C; HBV, chronic hepatitis B; ALD, alcoholic liver disease) and by treatment was performed.MethodsA cohort of 17 664 patients was assembled using linked Surveillance, Epidemiology, and End Results and Medicare data from 1991 to 2011 with confirmed diagnosis of HCC.ResultsThe cohort was mostly male, aged 70 (21‐106) years, without cardiovascular disease, and had liver cirrhosis without decompensation, metastatic HCC or large tumour size (>5 cm). The NAFLD‐HCC group was mostly female and older with more cardiovascular disease, metastatic HCC, and large tumour size and less cirrhosis and decompensated liver disease than the non‐NAFLD‐HCC groups. The NAFLD group was 47% less likely to receive any curative treatment as compared with non‐NAFLD aetiologies (OR 0.53, P < .001). NAFLD‐HCC had worse median survival after OLT (3.2, 0‐12.9 years, P = .01) but had improved survival after resection (2.4, 0‐12.0 years, P < .001) as compared with non‐NAFLD‐HCC. No significant survival differences existed for RFA by HCC aetiology. NAFLD was not an independent predictor of mortality after OLT, resection or RFA.ConclusionPatients with NAFLD‐HCC had worse survival after OLT but favourable survival after resection, particularly in the absence of cirrhosis, as compared with non‐NAFLD‐HCC aetiologies.