HCC Screening for Patients With NAFLD-Related Cirrhosis

Findings from a new study support regular screening for hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease (NAFLD)-related cirrhosis. Researchers published their findings in Clinical Gastroenterology and Hepatology.

The systematic review and meta-analysis, which included 18 studies spanning 470,404 patients, investigated the incidence of HCC in patients with NAFLD.

“When looking at studies that only included patients with cirrhosis, the incidence rate of HCC was 3.78 per 100 person-years (95% CI, 2.47–5.78), a finding of similar magnitude to the rates reported in patients with cirrhosis of other etiologies,” researchers wrote. “It is noteworthy that this rate (and its lower confidence interval limit) lie above the 1.5% annual risk threshold usually accepted to recommend regular HCC surveillance.”

Among patients with NAFLD at a stage earlier than cirrhosis, the HCC incident rate was 0.03 per 100 person-years, according to the study.

“On the basis of the currently assessed evidence, it could be assumed that our estimation of the incidence rate of HCC in non-cirrhotic livers of 0.03 per 100 person-years (95% CI, 0.01–0.07) does not support HCC screening in non-cirrhotic patients. This incidence reflected the rate of HCC among a heterogeneous group of patients, including those with simple steatosis and different degrees of fibrosis,” researchers pointed out. “This is of utmost relevance considering that those patients with more advanced fibrosis have been suggested to be at higher risk of HCC.”

While the HCC incidence rate jumped to 3.78 per 100 person-years among patients with NAFLD and cirrhosis, a separate analysis that focused on patients with NAFLD -related cirrhosis who were enrolled in dedicated surveillance programs found an even higher HCC incidence rate: 4.62 per 100 person-years.

“In conclusion, this meta-analysis of observational studies provides pooled estimates of the incidence of HCC in patients with nonalcoholic fatty liver disease. Even with high heterogeneity, our results support that HCC surveillance is beneficial in patients with nonalcoholic fatty liver disease-related liver cirrhosis,” researchers wrote.

—Jolynn Tumolo

Reference:
Orci LA, Sanduzzi-Zamparelli M, Caballol B, et al. Incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: a systematic review, meta-analysis, and meta-regression. Clin Gastroenterol Hepatol. 2022;20(2):283-292.e10. doi:10.1016/j.cgh.2021.05.002