Severe NAFLD boosts liver cancer risk

Last Updated: 2018-09-04

By Ankur Banerjee

(Reuters Health) - People with advanced cases of nonalcoholic fatty liver disease (NAFLD) may need to be monitored for liver cancer, a large U.S. study suggests.

Fatty liver disease is known to be linked with a higher risk of hepatocellular carcinoma (HCC). But it hasn't been clear whether some patients are more at risk than others.

The new study showed that when NAFLD progresses to cirrhosis, the risk for HCC is dramatically higher.

The findings suggest that people with NAFLD and cirrhosis should be monitored for HCC, the authors wrote in Gastroenterology, online August 23.

Among people with less severe NAFLD, the risk of liver cancer was not particularly high.

Therefore, the need for regular monitoring doesn't apply to everyone with NAFLD, Dr. Talal Adhami told Reuters Health in a phone interview. Adhami, a member of the American Liver Foundation's National Medical Advisory Committee, was not involved in the study.

In fact, most people with NAFLD never develop cirrhosis. In one earlier study, for example, only 5% of people with NAFLD developed liver scarring during roughly eight years of follow-up.

For the current study, the researchers analyzed Veterans Health Administration data on nearly 300,000 people with NAFLD and a similar number of people with healthy livers who were tracked for an average of 11 years.

Over the course of a year, roughly one case of liver cancer was diagnosed in every 50,000 patients with healthy livers. Not surprisingly, the rate was higher among people with NAFLD: one case of cancer for every 5,000 people.

But for patients with NAFLD and cirrhosis, the risk was markedly higher. Over the course of a year, researchers diagnosed more than 50 cases for every 5,000 patients with advanced liver disease.

The study also found higher rates of HCC in men and older patients, and lower rates in women and patients under age 45. The risk was highest in older Hispanic people and relatively low in African-American adults.

Study leader Dr. Fasiha Kanwal, of Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, said in a statement the study was the first large, diverse cohort study to quantify the risk of HCC in patients with NAFLD.

"This study gives an idea of whom you need to put on your radar for screening and which other patients have less risk of developing HCC," Adhami said.

SOURCE: http://bit.ly/2LR3hgR

Gastroenterology 2018.