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Cited by 166Hepatocellular Carcinoma Treatment and PrognosisLiver Disease Diagnosis and TreatmentLiver physiology and pathology

Characterization of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) patients without cirrhosis

Mohamad, Bashar, Shah, Vaishal, Onyshchenko, Mykola, Elshamy, Mohammed, Aucejo, Federico, Lopez, Rocio, Hanouneh, Ibrahim A., Alhaddad, Razan +1 more·2016·Hepatology International
DOI 10.1007/s12072-015-9679-0
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Abstract

Background The incidence of hepatocellular carcinoma (HCC) has increased significantly in United States over the last few decades in parallel with the epidemic of nonalcoholic fatty liver disease (NAFLD). Limited data suggests that HCC could arise in steatotic liver without the presence of cirrhosis. The present study was conducted to characterize patients with NAFLD presenting with HCC in non-cirrhotic liver (NCL) compared to the NAFLD- HCC patients in association with cirrhotic liver (CL).Methods A retrospective analysis of all patients diagnosed with HCC and NAFLD diagnosis seen at our institution between 2003 and 2012 was done. The patients were characterized based on demographic and clinical variables as well as histological and tumor features. Comparisons between the NCL and CL groups were done using analysis of variance (ANOVA) or the non-parametric Kruskal-Wallis tests and Pearson's chi-square tests or Fisher's Exact tests as appropriate. P value of <0.05 was considered statistically significant.Results Thirty-six patients with NAFLD and HCC in NCL (HCC-NCL group) were identified and compared to 47 patients with NAFLD-HCC and Liver Cirrhosis (HCC-LC group). Liver fibrosis was not present in 55.9 % of patients in the HCC-NCL group (F0), stage 1 was present in 17.6 %, stage 2 in 8.8 % and stage 3 in 17.6 %. Lobular inflammation was present in 63.6 % of non-cirrhotic patients. Patients in the HCC-NCL were older (67.5 ± 12.3 vs. 62.7 ± 8.1 years), and less likely to be obese (52 % vs. 83 %) or have type 2 diabetes (38 % vs. 83 %), with p value <0.05 for all. More importantly, compared with the HCC-CL group, those in the HCC-NCL group were more likely to present with a single nodule (80.6 % vs. 52.2 %), larger nodule size (>5 cm) (77.8 % vs. 10.6 %), and receive hepatic resection as the modality of HCC treatment (66.7 % vs. 17 %); and were less likely to receive loco-regional therapy (22.3 % vs. 61.7 %) or orthotopic liver transplantation (OLT) (0 % vs. 72.3 %), with p value <0.001 for all. Furthermore, 86 % of patients without cirrhosis had HCC recurrence compared to only 14 % in patients with cirrhosis (p < 0.001). Unadjusted analysis indicates that non-cirrhotics had worse survival with mortality rate of 47 % vs. 28 % in CL group (p = 0.03); however this difference in survival between two groups was not significant after adjusting for age or OLT (p > 0.05).Conclusion Patients with HCC in the absence of liver cirrhosis are more likely to present at an older age with larger tumor and have higher rates of tumor recurrence. Studies to assess the cost-effectiveness of HCC surveillance in this group should be conducted.

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Crossref · 10.1007/s12072-015-9679-0

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  • In a retrospective analysis of individuals with MASLD diagnosed with HCC between 2003 and 2012, those with HCC on a non-cirrhotic liver more frequently had a larger nodule size and/or a greater rate of HCC recurrence than those with cirrhosis.

    “In a retrospective analysis of individuals with MASLD who were diagnosed with HCC between 2003 and 2012, those with HCC on a non-cirrhotic liver more frequently had a larger nodule size and/or a greater rate of HCC recurrence than those with cirrhosis. 235”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [235]

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Authors
Mohamad, B., Shah, V., Onyshchenko, M., Elshamy, M., Aucejo, F., Lopez, R., Hanouneh, I. A., Alhaddad, R., & Alkhouri, N.
Affiliations
Cleveland Clinic (US)
Corresponding author
Alkhouri, Naim
ORCID
Venue
Hepatology International
Publisher
Springer Science and Business Media LLC
Published
2015-11-11
Volume
10
Issue
4
Pages
632-639
ISSN
  • 1936-0533 (ISSN-L)
  • 1936-0541
DOI
10.1007/s12072-015-9679-0
OpenAlex
W2117454090
Cited by
166
References
35
Citations by year
2026: 5 · 2025: 16 · 2024: 8 · 2023: 18 · 2022: 24 · 2021: 24 · 2020: 23 · 2019: 21 · 2018: 11 · 2017: 9 · 2016: 7
FWCI
5.33
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Hepatology International (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
Keywords
hepatocellular carcinoma, non-alcoholic fatty liver disease, non-cirrhotic liver, liver cirrhosis, liver fibrosis, lobular inflammation, hepatectomy, liver transplantation, survival outcomes, prognostic factors, obesity, type 2 diabetes
MeSH terms
Aged, Female, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Risk Factors, Survival Analysis, Non-alcoholic Fatty Liver Disease

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