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Hepatocellular cancer: The impact of obesity, type 2 diabetes and a multidisciplinary team
Open accessAbstract
Background & aims Hepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis.Methods Following the introduction of centralised specialist teams to manage patients with cancer in England, we characterised the demographics of patients with HCC referred to the Newcastle-upon-Tyne Hospitals NHS Foundation Trust between 2000 and 2010. Regional HCC mortality data was from Public Health England.Results HCC related mortality in the region rose 1.8 fold in 10 years, from 2.0 to 3.7 per 100,000. 632 cases were reviewed centrally, with 2-3 fold increases in referrals of patients with associated hepatitis C, alcoholic liver disease or no chronic liver disease and a >10 fold increase in HCC associated with non-alcoholic fatty liver disease (NAFLD). By 2010 NAFLD accounted for 41/118 (34.8%) cases. Irrespective of associated etiologies, metabolic risk factors were present in 78/118 (66.1%) cases in 2010, associated with regional increases in obesity and diabetes. Median overall survival was just 10.7 months. Although patients with NAFLD associated HCC were older (71.3 yr vs. 67.1 yr; p<0.001) and their cancers less often detected by surveillance, their survival was similar to other etiologies. This was attributed to significantly higher incidental presentation (38.2%) and lower prevalence of cirrhosis (77.2%).Conclusions HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most of the cases is poor, but older patients with co-morbidities can do well, managed, within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.
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“In a tertiary centre for HCC referral in Northern England, 231 individuals with HCC due to MASLD had a lower prevalence of cirrhosis (77.2%) than those with other aetiologies.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [231]
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Ester, C. C., Cerban, R., Iacob, S., Pietrăreanu, C., Constantin, G., Pâslaru, L., Ichim, S., Lita, M., Vădan, R., Grancea, C., et al. (2018) · Chirurgia · doi:10.21614/chirurgia.113.4.534 · Cited by 2
“The occurrence of hepatocellular carcinoma associated to NAFLD/cryptogenic cirrhosis is considered to be 10 times higher in patients with type 2 diabetes mellitus and obesity(4).”
BackgroundLiver Cancer (Current Therapies)
DelaCourt, A., & Mehta, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820472-6.00007-4
Diabetes, dyslipidemia, and death from hepatocellular carcinoma in the middle‐aged and elderly
Cross, T. (2014) · Hepatology · doi:10.1002/hep.27419 · Cited by 2
Williams, R. L. (2016) · doi:10.1002/9781118924938.ch23 · Cited by 2
A Polymorphism in the FGF21 Gene is a Novel Risk Variant for Metabolic-Associated Steatohepatitis
Elsayed, A. (2020) · The Sydney eScholarship Repository (The University of Sydney) · Cited by 2
Non‐Alcoholic Fatty Liver Disease
Hardy, T., & Day, C. P. (2018) · Wiley eBooks · doi:10.1002/9781119237662.ch28 · Cited by 2
Non-Alcoholic Fatty Liver Disease and Steatohepatitis
Govaere, O., & Anstee, Q. M. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-821618-7.00265-0 · Cited by 2
Hepatocellular carcinoma surveillance in cirrhotic patients: Beyond guidelines
Elsayed, M. O. K. (2023) · Gastroenterology and Functional Medicine · doi:10.54844/gfm.2023.439 · Cited by 3
Hepatocellular carcinoma management in older adults and its relation with frailty
Messina, G., & Palmieri, V. O. (2025) · Geriatric Care · doi:10.4081/gc.2025.13157 · Cited by 1
HCC in MASLD: radiological appearance, diagnosis and treatment
Burgio, M. D., Cannella, R., Vernuccio, F., Ronot, M., & Vilgrain, V. (2025) · Hepatoma Research · doi:10.20517/2394-5079.2024.117 · Cited by 1
Ipragliflozin improves the hepatic outcomes of patients with diabetes with NAFLD
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Yang, X., Yin, X., Wu, H., Li, Q., & Shen, Y. (2025) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000872 · Cited by 1
“When the age exceeds 85 years, these chronic diseases may become dominant causes of death, competing with LCDMDS (48,49).”
Chen, D., Nie, Y., Shi, L., Zhong, D.-F., Wu, J., Jin, B., & Liu, D. (2025) · Molecular Biotechnology · doi:10.1007/s12033-025-01494-6 · Cited by 2
“Such high mortality and increasing trends render non-alcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) a significant epidemiological hazard that cannot be overlooked [7, 8].”
Luo, Z., Zhang, Y., Guo, C., Chen, L., Ma, Q., Wang, Y., Tang, Y., Zhang, J., & Chen, C. (2025) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2025.149026 · Cited by 1
Khaled, K., Jardaly, H., & Oh, B. (2026) · Onco · doi:10.3390/onco6010005 · Cited by 1
“The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study in male smokers also showed no associations with fruits and berries [141,142].”
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Non-Alcoholic Fatty Liver Disease
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Non-Alcoholic Fatty Liver Disease – Changing the Prevalence of Liver Cancer?
Campana, B., Semela, D., Heim, M. H., & Bernsmeier, C. (2015) · EMJ Hepatology · doi:10.33590/emjhepatol/10314903 · Cited by 1
Predictors of Clinical Complications of Cirrhosis
Wedd, J. P., Kalra, A., & Biggins, S. W. (2015) · Springer eBooks · doi:10.1007/978-3-319-13614-1_4 · Cited by 1
Beeman, S. C., & Garbow, J. R. (2017) · Springer eBooks · doi:10.1007/978-3-319-61401-4_10 · Cited by 1
Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?
Chin, L. T. L., Lim, Y. J., & Choo, W. L. (2019) · American Journal of Speech-Language Pathology · doi:10.1044/2019_ajslp-18-0207 · Cited by 1
Metadata
- Authors
- Dyson, J., Jaques, B., Chattopadyhay, D., Lochan, R., Graham, J., Das, D., Aslam, T., Patanwala, I., Gaggar, S., Cole, M., Sumpter, K., Stewart, S., Rose, J., Hudson, M., Manas, D., & Reeves, H. L.
- Affiliations
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Newcastle University (GB)
- Corresponding author
- Reeves, Helen L.
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 60
- Issue
- 1
- Pages
- 110-117
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2076341209
- Cited by
- 603
- References
- 25
- Citations by year
- 2026: 23 · 2025: 32 · 2024: 45 · 2023: 43 · 2022: 72 · 2021: 65 · 2020: 63 · 2019: 60 · 2018: 57 · 2017: 48 · 2016: 38 · 2015: 33 · 2014: 18
- FWCI
- 19.26
- Type
- journal article
- Language
- en
- Open access
- green
- zenodo.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
- Keywords
- hepatocellular carcinoma, obesity, type 2 diabetes, non-alcoholic fatty liver disease, HCC mortality, chronic liver disease, hepatitis C, alcoholic liver disease, metabolic risk factors, multidisciplinary cancer care, cancer surveillance, liver cirrhosis, overall survival, cancer incidence trends
- MeSH terms
- Age Factors, Aged, Diabetes Mellitus, Type 2, Fatty Liver, Humans, Liver Neoplasms, Middle Aged, Obesity, Risk Factors, Non-alcoholic Fatty Liver Disease
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