The occurrence of hepatocellular carcinoma in different risk stratifications of clinically noncirrhotic nonalcoholic fatty liver disease |
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| Authors: | Teng‐Yu Lee Jaw‐Ching Wu Shi‐Hang Yu Jaw‐Town Lin Ming‐Shiang Wu Chun‐Ying Wu |
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| Institution: | 1. Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan;2. Department of Medicine, Chung Shan Medical University, Taichung, Taiwan;3. Institute of Clinical Medicine and Genomic Research Center, National Yang‐Ming University, Taipei, Taiwan;4. Translational Research Division, Medical Research Department, Taipei Veterans General Hospital, Taipei, Taiwan;5. School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan;6. Department of Internal Medicine, E‐Da Hospital/I‐Shou University, Kaohsiung, Taiwan;7. Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan;8. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;9. Faculty of Medicine, School of Medicine, National Yang‐Ming University, Taipei, Taiwan;10. College of Public Health and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan;11. Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan |
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| Abstract: | Nonalcoholic fatty liver disease (NAFLD) may be a cause of hepatocellular carcinoma (HCC), but its high prevalence challenges current surveillance strategies. We aimed to evaluate HCC incidences in different risk stratifications for noncirrhotic NAFLD. Using Taiwan's National Health Insurance Research Database, we located 31,571 patients with NAFLD between the years 1998 and 2012. After excluding other causes of hepatitis, underlying cirrhosis or malignancy, 18,080 patients were recruited for final analysis. Cumulative incidences of HCC were analyzed after adjusting for competing mortality. With a median follow‐up duration of 6.32 years in the study cohort, the 10‐year cumulative incidence of HCC was 2.73% 95% confidence interval (CI): 1.69–3.76%]. Hepatoprotectant was used as a surrogate marker for elevated serum alanine transaminase (ALT). After adjusting for age, gender, hypertension, hypercholesterolemia, diabetes mellitus, gout, statin use, metformin use and aspirin use, elevated ALT was independently associated with an increased HCC risk hazard ratio (HR) 6.80, 95% CI: 3.00–15.42; p < 0.001]. Multivariate stratified analysis verified this association in all subgroups (HR> 1.0). Moreover, increased age (HR 1.08 per year, 95% CI: 1.05–1.11) and statin use (HR 0.29, 95% CI: 0.12–0.68) were also identified as independent risk factors. The 10‐year cumulative HCC incidence was highest in older (age >55 years) patients with ALT elevation (12.41%, 95% CI: 5.99–18.83%), but lowest in younger patients without ALT elevation (0.36%, 95% CI: 0–1.08%). The incidence of HCC was relatively low in patients with clinically noncirrhotic NAFLD, however, HCC risk was significantly increased in older patients experiencing an elevated serum ALT. |
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| Keywords: | fatty liver hepatoma transaminase incidence |
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