Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1189-1196
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1189
Characteristics of hepatocellular carcinoma in cirrhotic and non-cirrhotic non-alcoholic fatty liver disease
Christopher Leung, Sern Wei Yeoh, Desmond Patrick, Shara Ket, Kaye Marion, Paul Gow, Peter W Angus
Christopher Leung, Sern Wei Yeoh, Desmond Patrick, Shara Ket, Paul Gow, Peter W Angus, Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria 3084, Australia
Christopher Leung, Paul Gow, Peter W Angus, Department of Medicine, The University of Melbourne, Austin Campus, Heidelberg, Victoria 3084, Australia
Kaye Marion, Statistics and Operations Research Group, School of Mathematical and Geospatial Sciences College of Science, Engineering and Health, RMIT University, Melbourne, Victoria 3000, Australia
Author contributions: Leung C and Yeoh SW contributed equally; Leung C, Yeoh SW and Ket S planned the design of the study; Yeoh SW and Patrick D aided in data collection; Marion K performed statistical analysis; Leung C, Yeoh SW, Gow P and Angus PW performed intellectual analysis and interpretation of the data; Leung C, Yeoh SW, Patrick D, Ket S, Marion K, Gow P and Angus PW aided in manuscript preparation.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christopher Leung, MBBS, FRACP, Liver Transplant Unit, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia. chris.leung@y7mail.com
Telephone: +614-3-94965000 Fax: +614-3-94963487
Received: June 1, 2014
Peer-review started: June 2, 2014
First decision: June 27, 2014
Revised: August 25, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: January 28, 2015
Processing time: 240 Days and 5.7 Hours
Abstract

AIM: To determine characteristics and prognostic predictors of patients with hepatocellular carcinoma (HCC) in association with non-alcoholic fatty liver disease (NAFLD).

METHODS: We reviewed the records of all patients with NAFLD associated HCC between 2000 and 2012. Data collected included demographics; histology; presence or absence of cirrhosis, size and number of HCC, alpha-fetoprotein, body mass index (BMI), and the presence of diabetes, hypertension, or dyslipidaemia.

RESULTS: Fifty-four patients with NAFLD associated HCC were identified. Mean age was 64 years with 87% male. Fifteen percent (8/54) were not cirrhotic. 11%, 24% and 50% had a BMI of < 25 kg/m2, 25-29 kg/m2 and ≥ 30 kg/m2 respectively. Fifty-nine percent were diabetic, 44% hypertensive and 26% hyperlipidaemic. Thirty-four percent of the patients had ≤ 1 of these risk factors. Non-cirrhotics had a significantly larger mean tumour diameter at diagnosis than cirrhotics (P = 0.041). Multivariate analysis did not identify any other patient characteristics that predicted the size or number of HCC.

CONCLUSION: HCC can develop in NAFLD without cirrhosis. At diagnosis such tumours are larger than those in cirrhotics, conferring a poorer prognosis.

Keywords: Hepatocellular carcinoma; Non-alcoholic fatty liver disease; Cryptogenic cirrhosis; Metabolic syndrome; Screening

Core tip: Our study confirms that hepatocellular carcinoma can occur in non-cirrhotic non-alcoholic fatty liver disease, the incidence of which is rising worldwide. Moreover, these cancers were found to be significantly larger and more likely to be beyond Milan criteria for liver transplantation than those occurring in cirrhotic patients. Further research is needed to identify clinical risk factor profiles predisposing to cancer development in patients with non-alcoholic fatty liver disease such that screening if implemented can be appropriately targeted.