Maria Reig1, Martina Gambato2, Nancy Kwan Man3, John P Roberts4, David Victor5, Lorenzo A Orci6, Christian Toso6. 1. Barcelona Clinic Liver Cancer (BCLC) Group, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain. 2. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy. 3. Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong. 4. Department of Surgery, University of California, San Francisco, CA. 5. Underwood Center for Digestive Disorders, J.C. Walter Jr. Transplant Center, and Sherrie and Allan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX. 6. Divisions of Transplant and Abdominal Surgery, Department of Surgery, and Hepato-pancreato-biliary Center, University of Geneva Hospitals, Geneva, Switzerland.
Abstract
BACKGROUND: Patients with nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatocellular carcinoma (HCC), but the magnitude of the association still needs to be determined to define the need for a specific surveillance strategy. METHODS: We based our assessment on a previously published review by White et al (1992-2011) and on a systematic review(2012-2017). RESULTS: The new search identified 328 abstracts. Combining both eras (1992-2011 and 2012-2017), 25 studies were included in the analysis. Four were prospective, 2 described a retrospective analysis of a prospective database, and the others were retrospective. All studies were published after 2004, but the inclusion period of half of them ended before the year 2000. Studies showed variation in the definition of NAFLD, in the incidence of fibrosis/cirrhosis, in the presence of comorbidities (potentially affecting HCC incidence), and in the type and duration of screening. Considering only studies strictly including patients with or without cirrhosis, the reported incidence of HCC in NAFLD patients with cirrhosis was between 6.7 and 15% at 5 to 10 years, whereas the incidence in NAFLD patients without cirrhosis was 2.7% at 10 years and 23 per 100 000 person-years. CONCLUSIONS: Hepatocellular carcinoma screening in NAFLD patients with cirrhosis is mandatory. However, the currently observed low (and insufficiently documented) incidence of HCC in NAFLD patients without cirrhosis does not justify a systematic surveillance. Research efforts should focus on developing a score, which could aid the clinician in identifying NAFLD patients without cirrhosis who are at higher risk of developing HCC.
BACKGROUND:Patients with nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatocellular carcinoma (HCC), but the magnitude of the association still needs to be determined to define the need for a specific surveillance strategy. METHODS: We based our assessment on a previously published review by White et al (1992-2011) and on a systematic review(2012-2017). RESULTS: The new search identified 328 abstracts. Combining both eras (1992-2011 and 2012-2017), 25 studies were included in the analysis. Four were prospective, 2 described a retrospective analysis of a prospective database, and the others were retrospective. All studies were published after 2004, but the inclusion period of half of them ended before the year 2000. Studies showed variation in the definition of NAFLD, in the incidence of fibrosis/cirrhosis, in the presence of comorbidities (potentially affecting HCC incidence), and in the type and duration of screening. Considering only studies strictly including patients with or without cirrhosis, the reported incidence of HCC in NAFLDpatients with cirrhosis was between 6.7 and 15% at 5 to 10 years, whereas the incidence in NAFLDpatients without cirrhosis was 2.7% at 10 years and 23 per 100 000 person-years. CONCLUSIONS:Hepatocellular carcinoma screening in NAFLDpatients with cirrhosis is mandatory. However, the currently observed low (and insufficiently documented) incidence of HCC in NAFLDpatients without cirrhosis does not justify a systematic surveillance. Research efforts should focus on developing a score, which could aid the clinician in identifying NAFLDpatients without cirrhosis who are at higher risk of developing HCC.
Authors: Pierre Deltenre; Jochen Hampe; Felix Stickel; Stephan Buch; Hamish Innes; Hans Dieter Nischalke; Indra Neil Guha; Karl Heinz Weiss; Will Irving; Daniel Gotthardt; Eleanor Barnes; Janett Fischer; M Azim Ansari; Jonas Rosendahl; Shang-Kuan Lin; Astrid Marot; Vincent Pedergnana; Markus Casper; Jennifer Benselin; Frank Lammert; John McLauchlan; Philip L Lutz; Victoria Hamill; Sebastian Mueller; Joanne R Morling; Georg Semmler; Florian Eyer; Johann von Felden; Alexander Link; Arndt Vogel; Jens U Marquardt; Stefan Sulk; Jonel Trebicka; Luca Valenti; Christian Datz; Thomas Reiberger; Clemens Schafmayer; Thomas Berg Journal: Hepatol Commun Date: 2021-12-27