Clinicopathological Differences Between Resected Hepatocellular Carcinoma Caused by NAFLD/NASH and Other Etiologies

Patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH)-related hepatocellular carcinoma were more likely to have carcinomas that lacked liver fibrosis and carcinomas that were larger when compared to patients with hepatocellular carcinoma from other etiologies, according to a retrospective analysis. 

Surendra Pal Chaudhary, MD, Mass General Cancer Center and Harvard Medical School, Boston, MA, wrote of NAFLD/NASH-related hepatocellular carcinoma, it is “imperative to understand the key aspects of this disease better,” due to “the complexity of disease biology and the absence of effective screening guidelines, approved biomarkers, or effective treatment for NAFLD/NASH.”

This study included 260 patients with surgically resected hepatocellular carcinoma at Massachusetts General Hospital or Brigham and Women’s Hospital, both NAFLD/NASH-related (N = 110; NAFLD/NASH, n = 61; cryptogenic cirrhosis, n = 49) and other etiologies (n = 150). The patients included in the other etiologies cohort had known histories including chronic hepatitis C virus (HCV; n = 54), chronic hepatitis B virus (HBV; n = 41), concurrent chronic HBV and HCV (n = 6), alcohol-related cirrhosis (n = 43), hemochromatosis (n = 5), and alpha-1 antitrypsin deficiency (n = 1). 

NAFLD/NASH-related tumors were more likely to be >5 cm (66.0% vs 45%; P = .001). Those in the NAFLD/NASH cohort had lower rates of background liver fibrosis, lower aspartate aminotransferase (AST) and alanine transaminase (ALT) levels, and higher platelet counts than those in the other etiologies cohort (P < .01 for all). Median recurrence-free survival was similar between the 2 cohorts. While not a statistically significant difference, the median overall survival of patients in the NAFLD/NASH cohort was numerically shorter than those in the other etiologies cohort. There were no significant differences in the rates of lymphovascular or perineural invasion, histologic grade, or serum alpha fetoprotein (AFP) levels.

Dr Chaudhary et al concluded that patients with NAFLD/NASH hepatocellular carcinoma who underwent resection “had a greater median tumor size but did not have higher rates of other pathological features that portend a poor prognosis,” adding “the composite effect of liver factors, tumor factors, and patient factors evaluated in this study summed to no significant difference in [recurrence-free survival] or [overall survival] between the 2 cohorts.”

Source:

Chaudhary SP, Reyes S, Chase ML, et al. Resection of NAFLD/NASH-related hepatocellular carcinoma (HCC): Clinical features and outcomes compared with HCC due to other etiologies. Oncologist. Published online February 10, 2023. doi:10.1093/oncolo/oyac251