Incidence of hepatocellular carcinoma in nonalcoholic fatty liver disease without cirrhosis or advanced liver fibrosis

Hepatology Communications · 11 authors, 5 centres

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Among patients without cirrhosis, the annual incidence was 2.8 per 1000 person-years for those with FIB-4 >2.67 (likely advanced fibrosis) and 0.7 per 1000 person-years for those with FIB-4 <1.30 (excluding advanced fibrosis). The study has limitations including reliance on diagnostic codes, a potentially non-diverse population, and lack of histological confirmation for fibrosis and HCC diagnosis.

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cohort

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gastroenterology

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ORIGINAL PAPER

PMC10319365

Incidence of hepatocellular carcinoma in nonalcoholic fatty liver disease without cirrhosis or advanced liver fibrosis

Hepatology Communications

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ABSTRACT

Background: HCC can develop in the absence of cirrhosis in patients with NAFLD. We aimed to estimate the incidence of HCC in patients with NAFLD with and without cirrhosis or advanced liver fibrosis. Methods: We performed a cohort study to determine the incidence of HCC in patients with NAFLD identified by the International Classification of Diseases 9/10 codes in the electronic health records of a US health care system between 2004 and 2018. The incidence of HCC was stratified by the presence or absence of cirrhosis and by the Fibrosis-4 index (FIB-4) at the time of HCC diagnosis. Results: Of 47,165 patients with NAFLD aged 40–89 years, 981 (2.1%) developed HCC (mean follow-up 3.4 y). Among patients with HCC, 842 (85.8%) had cirrhosis, while 139 (14.2%) did not. Of the 139 patients with HCC without cirrhosis-related diagnostic codes, 26 (2.7%) had FIB-4 >2.67 (advanced fibrosis likely), whereas 43 (4.4%) had FIB-4 < 1.30 (excluding advanced fibrosis). The annual incidence of HCC in patients with NAFLD with and without cirrhosis was 23.6 and 1.1 per 1000 person-years, respectively. Among patients without cirrhosis, the annual incidence of HCC was 2.8 per 1000 person-years with FIB-4 >2.67 and 0.7 per 1000 person-years with FIB-4 <1.30. Patients with NAFLD and cirrhosis were 31.8 times (95% CI, 23.3–43.4) more likely to develop HCC than those without cirrhosis and FIB-4 <1.30, after adjustment for age and sex. Conclusions: Patients with NAFLD without cirrhosis nor advanced fibrosis have a low incidence of HCC.

CITATION EXPORT

Jaideep Behari, Amir Gougol, Renwei Wang et al.. Incidence of hepatocellular carcinoma in nonalcoholic fatty liver disease without cirrhosis or advanced liver fibrosis. Hepatology Communications. (2023). https://doi.org/10.1097/HC9.0000000000000183

AUTHORS

11 · 5 CENTRES

Jaideep Behari, Amir Gougol, Renwei Wang, Hung N Luu, Pedram Paragomi, Yi-Chuan Yu, Michele Molinari, Kapil Chopra, Shahid M Malik, David Geller, Jian-Min Yuan

1Division of Gastroenterology, Department of Medicine, Hepatology and Nutrition, School of Medicine, Pittsburgh, Pennsylvania, USA
2Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
3Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
4Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
5Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA