Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies

Surendra Pal Chaudhary; Stephanie Reyes; Matthew L Chase; Aparna Govindan; Lei Zhao; Jay Luther; Irun Bhan; Emily Bethea; Joseph W Franses; Elizabeth Paige Walsh; Leigh Anne Dageford; Shoko Kimura; Nahel Elias; Heidi Yeh; James Markman; Adel Bozorgzadeh; Kenneth Tanabe; Cristina Ferrone; Andrew X Zhu; Karin Andersson; Michael Thiim; Onofrio Antonio Catalano; Avinash Kambadakone; Parsia A Vagefi; Motaz Qadan; Daniel Pratt; Nikroo Hashemi; Kathleen E Corey; Joseph Misdraji; Lipika Goyal; Jeffrey W Clark

doi:10.1093/oncolo/oyac251

Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies

Oncologist. 2023 Apr 6;28(4):341-350. doi: 10.1093/oncolo/oyac251.

Authors

Surendra Pal Chaudhary¹, Stephanie Reyes², Matthew L Chase³, Aparna Govindan⁴, Lei Zhao⁵, Jay Luther⁶, Irun Bhan⁶, Emily Bethea⁶, Joseph W Franses¹, Elizabeth Paige Walsh¹, Leigh Anne Dageford⁷, Shoko Kimura⁷, Nahel Elias⁷, Heidi Yeh⁷, James Markman⁷, Adel Bozorgzadeh⁷, Kenneth Tanabe⁸, Cristina Ferrone⁸, Andrew X Zhu⁹, Karin Andersson⁶, Michael Thiim⁶, Onofrio Antonio Catalano¹⁰, Avinash Kambadakone¹⁰, Parsia A Vagefi¹¹, Motaz Qadan⁸, Daniel Pratt⁶, Nikroo Hashemi¹², Kathleen E Corey⁶, Joseph Misdraji¹³, Lipika Goyal¹, Jeffrey W Clark¹

Affiliations

¹ Division of Oncology, Mass General Cancer Center and Harvard Medical School, Boston, MA, USA.
² Duke University School of Medicine, Durham, NC, USA.
³ Beth Israel Deaconess Hospital, Needham, MA, USA.
⁴ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Transplantation Unit, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Jiahui Health, Jiahui International Cancer Center, Shanghai, People's Republic of China.
¹⁰ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Surgical Transplantation, University of Texas Southwestern, Dallas, TX, USA.
¹² Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Department of Pathology, Yale New Haven Hospital, Yale University, New Haven, CT, USA.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies.

Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients.

Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant.

Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.

Keywords: NAFLD; NASH; hepatocellular carcinoma; metabolic syndrome; outcome; steatohepatitis.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Carcinoma, Hepatocellular* / pathology
Female
Humans
Liver Cirrhosis / pathology
Liver Neoplasms* / pathology
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / surgery
Retrospective Studies

Grants and funding

SPORE P50 CA127003/CA/NCI NIH HHS/United States