Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of hepatocellular carcinoma (HCC) worldwide.
NAFLD-HCC often occurs in noncirrhotic liver raising important surveillance issues.
Dr Ratziu and colleagues from France determined the temporal trends for prevalence, clinical characteristics and outcomes of NAFLD-HCC in patients undergoing liver resection.
Consecutive patients with histologically confirmed HCC who underwent liver resection over a 20-year period.
NAFLD was diagnosed based on past or present exposure to obesity or diabetes without other causes of chronic liver disease.
The team included a total of 323 HCC patients, 12% with NAFLD.
From 1995-1999 to 2010-2014, the prevalence of NAFLD-HCC increased from 3% to 20%, respectively, and followed the temporal trends in the prevalence of metabolic risk factors, while hepatitis C-HCC decreased.
NAFLD-HCC occurred more frequently in the absence of bridging fibrosis/cirrhosis.
Within the NAFLD group, the researchers found that tumor characteristics were similar between F0-F2 and F3-F4 patients, except for a higher proportion of single nodules.
A total of 53% patients had tumour recurrence and 40% died.
The research team noted that NAFLD-HCC had similar time to recurrence and survival as HCCs of other etiologies.
Satellite nodules, tumor size, microvascular invasion and male sex but not the aetiology were independently associated with recurrence.
Dr Ratziu's team comments, "Non-alcoholic fatty liver disease increased substantially over the past 20 years among resectable HCCs."
"It is now the leading cause of HCC occuring without/or with only minimal fibrosis."
"NAFLD patients are older, with larger tumors while survival and recurrence rates are as severe as in other etiologies."