Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a systematic review and meta-analysis

Tan, Darren Jun Hao; Ng, Cheng Han; Lin, Snow Yunni; Pan, Xin; Tay, Phoebe Wen Lin; Lim, Wen Hui; Teng, Margaret; Syn, Nicholas; Lim, Gina; Yong, Jie Ning; Quek, Jingxuan; Xiao, Jieling; Dan, Yock Young; Siddiqui, Mohammad Shadab; Sanyal, Arun J.; Muthiah, Mark; Loomba, Rohit; Huang, Daniel Q.

doi:10.1016/s1470-2045(22)00078-x

Cited by 190 publications

(158 citation statements)

References 55 publications

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“…Hepatocellular carcinoma is an aggressive primary liver tumor that typically evolves in the setting of chronic liver disease [ 1 ]. Risk factors for HCC are significant in cirrhotic patients due to high levels of alcohol consumption.…”

Section: Introductionmentioning

confidence: 99%

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Immunotherapy as a Neoadjuvant Therapy for a Patient with Hepatocellular Carcinoma in the Pretransplant Setting: A Case Report

et al. 2022

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Systemic combination therapy of immune checkpoint inhibitors and vascular endothelial growth factors have provided the basis for improved outcomes in select patients with unresectable or metastatic hepatocellular carcinoma. However, for patients with resectable disease, surgery alone or an orthotopic liver transplant remains the standard of care. Within the realms of transplant oncology, neoadjuvant systemic therapy is currently being evaluated as a potential strategy to improve outcomes in patients with HCC. Here, we report excellent response with significant downstaging in a safe manner after neoadjuvant treatment with atezolizumab and bevacizumab in a patient diagnosed with poorly differentiated HCC. As a result of the significant response observed with safe outcomes, the patient was listed for orthotopic liver transplant (OLT) evaluation and transplanted successfully.

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Section: Introductionmentioning

confidence: 99%

“…Other risk factors include non-alcohol-associated steatohepatitis (NASH), or patients with chronic hepatitis B and C virus infection [ 2 , 3 , 4 ]. HCC comprises 75% of primary liver tumors with cholangiocarcinoma accounting for the remaining cases [ 1 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Immunotherapy as a Neoadjuvant Therapy for a Patient with Hepatocellular Carcinoma in the Pretransplant Setting: A Case Report

et al. 2022

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“…NAFLD is associated with higher cancer incidence rate ratio (2.0; 95% CI 1.5 to 2.9) in 4772 patients compared with 14 441 sex-matched and age-matched non-obese controls, with the greatest increase in HCC,17 which persists after controlling for diabetes 18. In a recent meta-analysis of 61 studies, including 94 636 individuals globally, patients who developed HCC on a background of NAFLD were older, had higher body mass index and were more likely to have metabolic comorbidities compared with HCC due to other causes 19. A total of 38.5% of patients with HCC in the context of NAFLD presented with HCC in a non-cirrhotic liver, compared with 14.6% for HCC due to other causes.…”

Section: Introductionmentioning

confidence: 99%

What’s new in non-alcoholic fatty liver disease?

Spiers

Brindley

et al. 2022

Frontline Gastroenterol

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Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with an estimated prevalence of 25% in the Western World. NAFLD is a broad spectrum of disease states and while most people with NAFLD do not have progressive disease, 10-20% of patients develop histological features of inflammation (non-alcoholic steatohepatitis), fibrosis, cirrhosis and its complications. Despite this large disease burden of significant clinical impact, most people living with NAFLD are undiagnosed, disease course prediction is imprecise and there are no treatments licensed for this condition. In this review, we discuss some of the recent developments in NAFLD, focusing on disease definition and diagnosis, risk stratification and treatments.

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“…1,2 The global prevalence of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) cirrhosis and NAFLD-related hepatocellular carcinoma (HCC) is rising rapidly in parallel with the obesity epidemic. [3][4][5][6] Patients with NASH cirrhosis are recommended to undergo 6-monthly HCC surveillance with ultrasound, with the aim of detecting HCC early. 7 However, NASH cirrhosis and obesity are associated with suboptimal visualisation quality on ultrasound (US).…”

mentioning

confidence: 99%

“…We thank Drs Lebossé and Caussy for their thoughtful comments regarding our study 1,2 . The global prevalence of non‐alcoholic fatty liver disease (NAFLD), non‐alcoholic steatohepatitis (NASH) cirrhosis and NAFLD‐related hepatocellular carcinoma (HCC) is rising rapidly in parallel with the obesity epidemic 3–6 . Patients with NASH cirrhosis are recommended to undergo 6‐monthly HCC surveillance with ultrasound, with the aim of detecting HCC early 7 .…”

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confidence: 99%

Editorial: screening for hepatocellular carcinoma in NAFLD cirrhosis—towards abbreviated MRI alternative in patients with obesity? Authors' reply

Huang

Loomba

2022

Aliment Pharmacol Ther

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We thank Drs Lebossé and Caussy for their thoughtful comments regarding our study. 1,2 The global prevalence of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) cirrhosis and NAFLD-related hepatocellular carcinoma (HCC) is rising rapidly in parallel with the obesity epidemic. [3][4][5][6] Patients with NASH cirrhosis are recommended to undergo 6-monthly HCC surveillance with ultrasound, with the aim of detecting HCC early. 7 However, NASH cirrhosis and obesity are associated with suboptimal visualisation quality on ultrasound (US). 8 Suboptimal visualisation quality on US performed for HCC surveillance is associated with false negative and false positive findings, potentially leading to harm. 9 Therefore, alternative surveillance strategies are required for patients with suboptimal visualisation quality on US, such as magnetic resonance imaging (MRI) protocols. 2,10 The current study represents the first prospective, head-to-head comparative study between US and abbreviated magnetic resonance imaging (AMRI) for HCC surveillance in NASH cirrhosis and suggests that AMRI provides better visualisation quality than US.We acknowledge that the number of included participants was modest, however, a-priori sample size calculation determined that the study was sufficiently powered to detect a difference in the proportion of severely limited exams between US and AMRI. 2 In addition, we would like to clarify that decompensated patients were not excluded from this study, however, the majority (96%) of included participants had a MELD score of <15. We completely agree with Drs Lebossé and Caussy that larger, prospective studies of patients with cirrhosis from aetiologies other than NAFLD and cost-effectiveness studies are required.

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Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a systematic review and meta-analysis

Cited by 190 publications

References 55 publications

Immunotherapy as a Neoadjuvant Therapy for a Patient with Hepatocellular Carcinoma in the Pretransplant Setting: A Case Report

Immunotherapy as a Neoadjuvant Therapy for a Patient with Hepatocellular Carcinoma in the Pretransplant Setting: A Case Report

What’s new in non-alcoholic fatty liver disease?

Editorial: screening for hepatocellular carcinoma in NAFLD cirrhosis—towards abbreviated MRI alternative in patients with obesity? Authors' reply

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