Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study

Fabio Piscaglia, Gianluca Svegliati Baroni, Andrea Barchetti, A Pecorelli, S. Marinelli, Claudio Tiribelli, Stefano Bellentani, Massimo Colombo, Roberta D'Ambrosio, Anna Ludovica Fracanzani, Silvia Fargion

Research output: Contribution to journalArticle

Abstract

Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC) and to compare them to those of hepatitis C virus (HCV)-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead-time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC patients, in contrast to the near totality of HCV-HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD-HCC, 25.5 months (95% confidence interval 21.9-29.1), than in those with HCV-HCC, 33.7 months (95% confidence interval 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD-HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827-838) © 2016 by the American Association for the Study of Liver Diseases.
Original languageEnglish
Pages (from-to)827-838
Number of pages12
JournalHepatology
Volume63
Issue number3
DOIs
Publication statusPublished - 2016

Cite this

Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. / Piscaglia, Fabio; Svegliati Baroni, Gianluca; Barchetti, Andrea; Pecorelli, A; Marinelli, S.; Tiribelli, Claudio; Bellentani, Stefano; Colombo, Massimo; D'Ambrosio, Roberta; Fracanzani, Anna Ludovica; Fargion, Silvia.

In: Hepatology, Vol. 63, No. 3, 2016, p. 827-838.

Research output: Contribution to journalArticle

Piscaglia, Fabio ; Svegliati Baroni, Gianluca ; Barchetti, Andrea ; Pecorelli, A ; Marinelli, S. ; Tiribelli, Claudio ; Bellentani, Stefano ; Colombo, Massimo ; D'Ambrosio, Roberta ; Fracanzani, Anna Ludovica ; Fargion, Silvia. / Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. In: Hepatology. 2016 ; Vol. 63, No. 3. pp. 827-838.
@article{c1923640498a4a49998d08d007913838,
title = "Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study",
abstract = "Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC) and to compare them to those of hepatitis C virus (HCV)-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead-time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50{\%} of NAFLD-HCC patients, in contrast to the near totality of HCV-HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD-HCC, 25.5 months (95{\%} confidence interval 21.9-29.1), than in those with HCV-HCC, 33.7 months (95{\%} confidence interval 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD-HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827-838) {\circledC} 2016 by the American Association for the Study of Liver Diseases.",
author = "Fabio Piscaglia and {Svegliati Baroni}, Gianluca and Andrea Barchetti and A Pecorelli and S. Marinelli and Claudio Tiribelli and Stefano Bellentani and Massimo Colombo and Roberta D'Ambrosio and Fracanzani, {Anna Ludovica} and Silvia Fargion",
note = "Cited By :17 Export Date: 28 March 2017",
year = "2016",
doi = "10.1002/hep.28368",
language = "English",
volume = "63",
pages = "827--838",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study

AU - Piscaglia, Fabio

AU - Svegliati Baroni, Gianluca

AU - Barchetti, Andrea

AU - Pecorelli, A

AU - Marinelli, S.

AU - Tiribelli, Claudio

AU - Bellentani, Stefano

AU - Colombo, Massimo

AU - D'Ambrosio, Roberta

AU - Fracanzani, Anna Ludovica

AU - Fargion, Silvia

N1 - Cited By :17 Export Date: 28 March 2017

PY - 2016

Y1 - 2016

N2 - Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC) and to compare them to those of hepatitis C virus (HCV)-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead-time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC patients, in contrast to the near totality of HCV-HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD-HCC, 25.5 months (95% confidence interval 21.9-29.1), than in those with HCV-HCC, 33.7 months (95% confidence interval 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD-HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827-838) © 2016 by the American Association for the Study of Liver Diseases.

AB - Nonalcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolve into hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. The aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC) and to compare them to those of hepatitis C virus (HCV)-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in secondary care Italian centers. Survival was modeled according to clinical parameters, lead-time bias, and propensity analysis. Compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern, and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC patients, in contrast to the near totality of HCV-HCC. Regardless of tumor stage, survival was significantly shorter (P = 0.017) in patients with NAFLD-HCC, 25.5 months (95% confidence interval 21.9-29.1), than in those with HCV-HCC, 33.7 months (95% confidence interval 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively, 38.6 versus 41.0 months, P = nonsignificant) Conclusions: NAFLD-HCC is more often detected at a later tumor stage and could arise also in the absence of cirrhosis, but after patient matching, it has a similar survival rate compared to HCV infection; a future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. (Hepatology 2016;63:827-838) © 2016 by the American Association for the Study of Liver Diseases.

U2 - 10.1002/hep.28368

DO - 10.1002/hep.28368

M3 - Article

VL - 63

SP - 827

EP - 838

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 3

ER -