Mohammad A Karim1, Amit G Singal2, Hye Chung Kum3, Yi-Te Lee4, Sulki Park3, Nicole E Rich2, Mazen Noureddin5, Ju Dong Yang6. 1. Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas; Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas. 2. Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas. 3. Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas. 4. California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California. 5. Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, California. 6. Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, California; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: judong.yang@cshs.org.
Abstract
BACKGROUND & AIMS: The extent to which nonalcoholic fatty liver disease (NAFLD) contributes to hepatocellular carcinoma (HCC) prevalence in contemporary practices and whether there are any etiologic differences in surveillance receipt, tumor stage, and overall survival (OS) remain unclear. We aimed to estimate the burden of NAFLD-related HCC and magnitude of associations with surveillance receipt, clinical presentation, and outcomes in a contemporary HCC cohort. METHODS: In a cohort of HCC patients from the Surveillance, Epidemiology and End Results-Medicare database between 2011 and 2015, we used multivariable logistic regression to identify factors associated with surveillance receipt, early-stage tumor detection, and curative treatment. Cox regression was used to identify factors associated with OS. RESULTS: Among 5098 HCC patients, NAFLD was the leading etiology, accounting for 1813 cases (35.6%). Compared with those with hepatitis C-related HCC, NAFLD was associated with lower HCC surveillance receipt (adjusted odds ratio, 0.22; 95% confidence interval [CI], 0.17-0.28), lower early-stage HCC detection (adjusted odds ratio, 0.49; 95% CI, 0.40-0.60), and modestly worse OS (adjusted hazard ratio, 1.20; 95% CI, 1.09-1.32). NAFLD subgroup analysis showed that early-stage HCC, absence of ascites/hepatic encephalopathy, surveillance, and curative treatment receipt were associated with improved OS. NAFLD patients with coexisting liver disease were more likely to have surveillance, early-stage detection, curative treatment, and improved OS than NAFLD patients without coexisting liver diseases. CONCLUSIONS: NAFLD is the leading etiology of HCC among Medicare beneficiaries. Compared with other etiologies, NAFLD was associated with lower HCC surveillance receipt, early-stage detection, and modestly poorer survival. Multifaceted interventions for improving surveillance uptake are needed to improve prognosis of patients with NAFLD-related HCC.
BACKGROUND & AIMS: The extent to which nonalcoholic fatty liver disease (NAFLD) contributes to hepatocellular carcinoma (HCC) prevalence in contemporary practices and whether there are any etiologic differences in surveillance receipt, tumor stage, and overall survival (OS) remain unclear. We aimed to estimate the burden of NAFLD-related HCC and magnitude of associations with surveillance receipt, clinical presentation, and outcomes in a contemporary HCC cohort. METHODS: In a cohort of HCC patients from the Surveillance, Epidemiology and End Results-Medicare database between 2011 and 2015, we used multivariable logistic regression to identify factors associated with surveillance receipt, early-stage tumor detection, and curative treatment. Cox regression was used to identify factors associated with OS. RESULTS: Among 5098 HCC patients, NAFLD was the leading etiology, accounting for 1813 cases (35.6%). Compared with those with hepatitis C-related HCC, NAFLD was associated with lower HCC surveillance receipt (adjusted odds ratio, 0.22; 95% confidence interval [CI], 0.17-0.28), lower early-stage HCC detection (adjusted odds ratio, 0.49; 95% CI, 0.40-0.60), and modestly worse OS (adjusted hazard ratio, 1.20; 95% CI, 1.09-1.32). NAFLD subgroup analysis showed that early-stage HCC, absence of ascites/hepatic encephalopathy, surveillance, and curative treatment receipt were associated with improved OS. NAFLD patients with coexisting liver disease were more likely to have surveillance, early-stage detection, curative treatment, and improved OS than NAFLD patients without coexisting liver diseases. CONCLUSIONS: NAFLD is the leading etiology of HCC among Medicare beneficiaries. Compared with other etiologies, NAFLD was associated with lower HCC surveillance receipt, early-stage detection, and modestly poorer survival. Multifaceted interventions for improving surveillance uptake are needed to improve prognosis of patients with NAFLD-related HCC.
Authors: Zobair M Younossi; Maria Stepanova; Youssef Younossi; Pegah Golabi; Alita Mishra; Nila Rafiq; Linda Henry Journal: Gut Date: 2019-07-31 Impact factor: 23.059
Authors: Zobair Younossi; Maria Stepanova; Janus P Ong; Ira M Jacobson; Elisabetta Bugianesi; Ajay Duseja; Yuichiro Eguchi; Vincent W Wong; Francesco Negro; Yusuf Yilmaz; Manuel Romero-Gomez; Jacob George; Aijaz Ahmed; Robert Wong; Issah Younossi; Mariam Ziayee; Arian Afendy Journal: Clin Gastroenterol Hepatol Date: 2018-06-14 Impact factor: 11.382
Authors: Amit G Singal; Adam C Yopp; Samir Gupta; Celette Sugg Skinner; Ethan A Halm; Eucharia Okolo; Mahendra Nehra; William M Lee; Jorge A Marrero; Jasmin A Tiro Journal: Cancer Prev Res (Phila) Date: 2012-07-30
Authors: Lindsey Enewold; Helen Parsons; Lirong Zhao; David Bott; Donna R Rivera; Michael J Barrett; Beth A Virnig; Joan L Warren Journal: J Natl Cancer Inst Monogr Date: 2020-05-01
Authors: Yi-Te Lee; Jasmine J Wang; Michael Luu; Hsian-Rong Tseng; Nicole E Rich; Shelly C Lu; Nicholas N Nissen; Mazen Noureddin; Amit G Singal; Ju Dong Yang Journal: Hepatology Date: 2021-06-11 Impact factor: 17.425
Authors: Mònica Pons; Jesús Rivera-Esteban; Ramiro Manzano; Juan Bañares; María Bermúdez; Víctor Vargas; Maria Teresa Salcedo-Allende; Lluís Castells; Salvador Augustin; Beatriz Mínguez; Juan M Pericàs Journal: J Clin Med Date: 2022-04-27 Impact factor: 4.964