학술논문
Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies
Original Article
Original Article
Document Type
Academic Journal
Author
Chaudhary, Surendra Pal; Reyes, Stephanie; Chase, Matthew L.; Govindan, Aparna; Zhao, Lei; Luther, Jay; Bhan, Irun; Bethea, Emily; Franses, Joseph W.; Walsh, Elizabeth Paige; Dageford, Leigh Anne; Kimura, Shoko; Elias, Nahel; Yeh, Heidi; Markman, James; Bozorgzadeh, Adel; Tanabe, Kenneth; Ferrone, Cristina; Zhu, Andrew X.; Andersson, Karin; Thiim, Michael; Catalano, Onofrio Antonio; Kambadakone0, Avinash; Vagefi, Parsia A.; Qadan, Motaz; Pratt, Daniel; Hashemi, Nikroo; Corey, Kathleen E.; Misdraji, Joseph; Goyal, Lipika; Clark, Jeffrey W.
Source
The Oncologist. April 2023, Vol. 28 Issue 4, p341, 10 p.
Subject
Language
English
ISSN
1083-7159
Abstract
Implications for Practice There is an increasing prevalence of NAFLD/NASH-related HCC, especially in the Western world. The complexity of disease biology and the absence of effective screening guidelines, approved biomarkers, [...]
Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies. Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients. Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P= .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P= .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant. Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs. Key words: steatohepatitis; NAFLD; NASH; hepatocellular carcinoma; outcome; metabolic syndrome.
Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies. Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients. Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P= .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P= .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant. Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs. Key words: steatohepatitis; NAFLD; NASH; hepatocellular carcinoma; outcome; metabolic syndrome.