Justin C Brown1, Michael O Harhay2, Meera N Harhay3. 1. Division of Population Science, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, United States; Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, United States. Electronic address: justinc_brown@dfci.harvard.edu. 2. Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, United States. 3. Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, United States.
Abstract
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) may foster a tumor microenvironment that promotes cancer recurrence and progression. We examined the relationship between NAFLD and mortality among a sample of cancer survivors. METHODS: Ultrasonography was used to assess hepatic steatosis, and standardized algorithms were used to define NAFLD. Study endpoints included all-cause, cancer-specific, and cardiovascular-specific mortality. RESULTS: Among 387 cancer survivors, 17.6% had NAFLD. During a median of 17.9 years of follow up, we observed 196 deaths from all causes. In multivariable-adjusted regression models, NAFLD was associated with an increased risk of all-cause mortality [HR: 2.52, 95% CI: 1.47-4.34; P=0.001]. We observed 86 cancer-specific deaths. In multivariable-adjusted regression models, NAFLD was associated with an increased risk of cancer-specific mortality [HR: 3.21, 95% CI: 1.46-7.07; P=0.004]. We observed 46 cardiovascular-specific deaths. In multivariable-adjusted regression models, NAFLD was not associated with an increased risk of cardiovascular-specific mortality [HR: 1.04, 95% CI: 0.30-3.64, P=0.951]. CONCLUSION: NAFLD is associated with an increased risk of all-cause and cancer-specific mortality among cancer survivors. This novel observation warrants replication. Evaluating the efficacy of interventions, such as lifestyle modification through weight loss and exercise, to improve NAFLD in this population may be considered.
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) may foster a tumor microenvironment that promotes cancer recurrence and progression. We examined the relationship between NAFLD and mortality among a sample of cancer survivors. METHODS: Ultrasonography was used to assess hepatic steatosis, and standardized algorithms were used to define NAFLD. Study endpoints included all-cause, cancer-specific, and cardiovascular-specific mortality. RESULTS: Among 387 cancer survivors, 17.6% had NAFLD. During a median of 17.9 years of follow up, we observed 196 deaths from all causes. In multivariable-adjusted regression models, NAFLD was associated with an increased risk of all-cause mortality [HR: 2.52, 95% CI: 1.47-4.34; P=0.001]. We observed 86 cancer-specific deaths. In multivariable-adjusted regression models, NAFLD was associated with an increased risk of cancer-specific mortality [HR: 3.21, 95% CI: 1.46-7.07; P=0.004]. We observed 46 cardiovascular-specific deaths. In multivariable-adjusted regression models, NAFLD was not associated with an increased risk of cardiovascular-specific mortality [HR: 1.04, 95% CI: 0.30-3.64, P=0.951]. CONCLUSION: NAFLD is associated with an increased risk of all-cause and cancer-specific mortality among cancer survivors. This novel observation warrants replication. Evaluating the efficacy of interventions, such as lifestyle modification through weight loss and exercise, to improve NAFLD in this population may be considered.
Authors: Cheryl L Rock; Colleen Doyle; Wendy Demark-Wahnefried; Jeffrey Meyerhardt; Kerry S Courneya; Anna L Schwartz; Elisa V Bandera; Kathryn K Hamilton; Barbara Grant; Marji McCullough; Tim Byers; Ted Gansler Journal: CA Cancer J Clin Date: 2012-04-26 Impact factor: 508.702
Authors: Wendy Demark-Wahnefried; Elizabeth A Platz; Jennifer A Ligibel; Cindy K Blair; Kerry S Courneya; Jeffrey A Meyerhardt; Patricia A Ganz; Cheryl L Rock; Kathryn H Schmitz; Thomas Wadden; Errol J Philip; Bruce Wolfe; Susan M Gapstur; Rachel Ballard-Barbash; Anne McTiernan; Lori Minasian; Linda Nebeling; Pamela J Goodwin Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-06-13 Impact factor: 4.254
Authors: Mariana Lazo; Ruben Hernaez; Mark S Eberhardt; Susanne Bonekamp; Ihab Kamel; Eliseo Guallar; Ayman Koteish; Frederick L Brancati; Jeanne M Clark Journal: Am J Epidemiol Date: 2013-05-23 Impact factor: 4.897