Relative Etiological Role of Prior Hepatitis B Virus Infection and Nonalcoholic Fatty Liver Disease in the Development of Non-B Non-C Hepatocellular Carcinoma in a Hepatitis B-Endemic Area

Cho, Eun Ju; Kwack, Min Sun; Jang, Eun Sun; You, Su Jong; Lee, Jeong-Hoon; Kim, Yoon Jun; Yoon, Jung‐Hwan; Lee, Hyo-Suk

doi:10.1159/000333210

Cited by 64 publications

(57 citation statements)

References 55 publications

(32 reference statements)

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“…In our local context, the prevalence of NASH risk factors, such as obesity, increased from 6% in 1998 to 10.8% in 2010, while diabetes mellitus increased from 9% in 1998 to 11.3% in 2010, which intuitively would translate into an increasing prominence of NASH and consequently NASH‐related (i.e., cryptogenic) HCC 10. This can also be extrapolated to many other countries that are afflicted by the burgeoning obesity and diabetes epidemic 31, 32, 33…”

Section: Discussionmentioning

confidence: 93%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

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Section: Discussionmentioning

confidence: 93%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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“…Interestingly, cHCC patients with anti-HBc antibodies were older, showed lower the MELD scores, AFP levels, lower AST/ALT levels, and a smaller proportion of patients with cirrhosis than patients with HBV HCC. [23]. In another study covering 2003-2012, cHCC comprised 6.8% of HCC cases [21].…”

Section: Comparisons According To the Presence Of Anti-hbc Antibodiesmentioning

confidence: 96%

“…In South Korea, the incidence of cryptogenic, or NBNCNA, HCC has reportedly increased from 2.3% to 12.2% [21][22][23][24]. Therefore, there is a need for better understanding of cHCC.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area

et al. 2015

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Objectives: Chronic hepatitis B virus (HBV) infection is the most common cause of hepatocellular carcinoma (HCC) in South Korea, but a high prevalence of metabolic diseases may result in increases in the incidence of cryptogenic HCC (cHCC). We studied characteristics of the cHCC in a single-center cohort. Methods: A cohort of 1,784 HCC patients newly diagnosed and treated at the National Cancer Center, Korea, between 2004 and 2009 was reviewed and analyzed. Results: The cause of HCC was categorized as cHCC, HBV, hepatitis C virus (HCV), or alcohol. Overall, 162 (9.1%) patients of the HCC cohort had cHCC, and their mean age was 61.9 years. The median survival of cHCC patients was 24.7 months, which was the second shortest among the four groups after HBV HCC. cHCC patients had the largest tumor size (mean 7.4 cm) and the second highest proportion of poor prognostic factors such as the proportion of poorly defined tumors and extrahepatic spread in imaging studies. cHCC patients had better survival than HBV HCC patients according to multivariate analysis. Among cHCC patients, 137 (84.6%) had anti-HBc IgG antibodies, but this sub-group had different clinical features to those of HBV HCC patients. The body mass index (BMI) and hyperglycemia and hypercholesterolemia levels in cHCC patients were similar to those in HCV and alcoholic HCC patients. Conclusions: Anti-HBc IgG antibodies were present in most cHCC patients, but cHCC patients had better survival than HBV HCC patients on multivariate analysis. However, cHCC patients had a larger mean tumor size and more aggressive tumor characteristics than HCV HCC or alcoholic HCC patients did. It is hoped that this study will contribute to a better understanding of cHCC in HBV-endemic areas.

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“…The prevalence of NAFLD‐related HCC in the general population is not well documented, with most studies reporting only the proportion of NAFLD‐related HCC in single or multiple institutions and a few studies utilizing a large transplant database or cancer registry to look into the impact of NAFLD‐related HCC in the respective countries where the studies were carried out. A summary of these studies can be found in Table . These studies are further discussed in the sections that follow.…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of non‐alcoholic fatty liver disease‐related hepatocellular carcinoma and its implications

2018

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Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer‐related mortality worldwide. Non‐alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver pathology that is characterized by the excessive accumulation of fat in the liver attributable to overnutrition and is strongly associated with the metabolic syndrome. Non‐alcoholic steatohepatitis is the more severe form of NAFLD that is defined histologically by the presence of lobular inflammation and hepatocyte ballooning. Non‐alcoholic steatohepatitis patients have a greater tendency to develop advanced liver fibrosis, cirrhosis, and HCC. This review focuses on the epidemiology of NAFLD‐related HCC and its implications. NAFLD has been estimated to contribute to 10–12% of HCC cases in Western populations and 1–6% of HCC cases in Asian populations. NAFLD‐related HCC is expected to increase in Asian populations, in line with the increased prevalence of NALFD similar to that of Western populations in recent years. The increasing burden of NAFLD‐related HCC over time has been demonstrated in studies from both Western and Asian populations. Certain factors such as ethnicity, obesity, and diabetes mellitus appear to have an incremental effect on the risk of developing HCC among NAFLD patients. The difficulty in identifying NAFLD patients with cirrhosis and the possibility of HCC developing in noncirrhotic NAFLD patients are challenges that need to be addressed. Further understanding of these gaps may contribute to better surveillance strategies for the early detection of HCC in NAFLD patients to reduce the mortality and improve the survival of these patients.

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Relative Etiological Role of Prior Hepatitis B Virus Infection and Nonalcoholic Fatty Liver Disease in the Development of Non-B Non-C Hepatocellular Carcinoma in a Hepatitis B-Endemic Area

Cited by 64 publications

References 55 publications

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Clinical Characteristics of Patients with Cryptogenic Hepatocellular Carcinoma in a Hepatitis B Virus-Endemic Area

Epidemiology of non‐alcoholic fatty liver disease‐related hepatocellular carcinoma and its implications

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