AASLD 2012-Connection between Fatty Liver Disease and the Increase in the Rate of Liver Cancer

The Connection between Fatty Liver Disease and the Increase in the Rate of Liver Cancer

Researchers at the University of Missouri determined that cirrhosis was not present in more than one-third of patients who had nonalcoholic fatty liver disease (NAFLD) that led to hepatocellular carcinoma (HCC). The records of 17,785 Medicare patients who had HCC were studied, and it was determined that 16 percent of those patients had NAFLD and no other way of developing cancer. About 64 percent of those patients had nonalcoholic steatohepatitis (NASH) that progressed to cirrhosis. A very surprising 36 percent of patients who developed HCC from fatty liver disease had no evidence of cirrhosis.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 5 percent of the US population has nonalcoholic steatohepatitis (NASH), which is a type of NAFLD that can lead to cirrhosis and liver cancer. Cirrhosis is damage to the liver tissue that leads to loss of liver function. Many more Americans -- between 10 and 20 percent more -- have NAFLD, which is the mere presence of fat in the liver, rather than NASH. Approximately 70 percent of those diagnosed with NASH are obese.

HCC is one of the few cancers growing in incidence. Fatty liver disease is the third most common risk factor of HCC in the United States. Determining that a great number of the population can have the more benign form of liver disease without any cirrhosis present yet still develop what is considered one of the deadliest cancers in the US should be of grave concern to a country that is facing an obesity epidemic.

The researchers also indicated that in recent years the incidence of NAFLD HCC without cirrhosis is increasing more rapidly than any other cause, which could be attributed to the obesity epidemic.
Dr. Jamal Ibdah spoke to the obesity epidemic and the rise in the rate of HCC, “According to current literature, we do not have a good explanation for the recent increase in the incidence of HCC in the US population. The incidence of HCC from hepatitis or alcohol is more or less stable in the last decade. Our findings provide a potential explanation to the recent increase in the incidence of HCC, which coincides with the obesity epidemic.”

Researchers did note, however, the better survival rate for patients with NAFLD HCC without cirrhosis.

“Our data suggest unique underlying pathophysiology for development of HCC in non-cirrhotic NAFLD and further studies are warranted in this regard,” said Dr. Ibdah. “This may lead to the discovery of new pathways that may become potential targets for new treatments for liver cancer.”

The results of this study have important implications for physicians treating patients with NAFLD. “Physicians should be more aware that patients can develop primary liver cancer from NAFLD without cirrhosis. Surveillance for cancer is typically performed in the setting of cirrhosis. Thus, patients with NAFLD and without cirrhosis may need to be considered for periodic surveillance for HCC,” said Dr. Ibdah.

Abstract title:
Nonalcoholic fatty liver disease without cirrhosis is an emergent and independent risk factor of hepatocellular carcinoma: A population based study

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AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting®, held in Boston, Massachusetts November 9 – 13, will bring together more than 9,000 researchers from 55 countries.

A pressroom will be available from November 10 at the annual meeting. For copies of abstracts and press releases, or to arrange researcher interviews, contact Gregory Bologna at 703-299-9766.