Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease

Hepatology, 04/27/2012

Patients with hepatocellular carcinoma (HCC) in the setting of nonalcoholic steatohepatitis (NASH) have less severe liver dysfunction at HCC diagnosis and better overall survival (OS) after curative treatment compared to counterparts with hepatitis C virus (HCV) and/or alcoholic liver disease.

Methods

  • Patient demographics and comorbidities, clinicopathologic data, and long-term outcomes among patients who underwent liver transplantation, hepatic resection, or radiofrequency ablation for HCC were reviewed.
  • From 2000 to 2010, 303 patients underwent curative treatment of HCC; 52 (17.2%) and 162 (53.5%) patients had NASH and HCV and/or alcoholic liver disease.
  • At HCC diagnosis, NASH patients were older (median age 65 versus 58 years), were more often female (48.1% versus 16.7%), more often had the metabolic syndrome (45.1% versus 14.8%), and had lower model for end-stage liver disease scores (median 9 versus 10) (all P < 0.05).

Results

  • NASH patients were less likely to have hepatic bridging fibrosis or cirrhosis (73.1% versus 93.8%; P < 0.001).
  • After a median follow-up of 50 months after curative treatment, the most frequent cause of death was liver failure.
  • Though there were no differences in recurrence-free survival after curative therapy (median, 60 versus 56 months; P = 0.303), NASH patients had longer overall survival (OS) (median not reached versus 52 months; P = 0.009) independent of other clinicopathologic factors and type of curative treatment.

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