title: Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease.
abstract: Concomitant increasing incidences of hepatocellular carcinoma (HCC) and nonalcoholic steatohepatitis (NASH) suggest that a substantial proportion of HCC arises as a result of hepatocellular injury from NASH. The aim of this study was to determine differences in severity of liver dysfunction at HCC diagnosis and long-term survival outcomes between patients undergoing curative therapy for HCC in the background of NASH compared to hepatitis C virus (HCV) and/or alcoholic liver disease (ALD). Patient demographics and comorbidities, clinicopathologic data, and long-term outcomes among patients who underwent liver transplantation, hepatic resection, or radiofrequency ablation for HCC were reviewed. From 2000 to 2010, 303 patients underwent curative treatment of HCC; 52 (17.2%) and 162 (53.5%) patients had NASH and HCV and/or alcoholic liver disease. At HCC diagnosis, NASH patients were older (median age 65 versus 58 years), were more often female (48.1% versus 16.7%), more often had the metabolic syndrome (45.1% versus 14.8%), and had lower model for end-stage liver disease scores (median 9 versus 10) (all P < 0.05). NASH patients were less likely to have hepatic bridging fibrosis or cirrhosis (73.1% versus 93.8%; P < 0.001). After a median follow-up of 50 months after curative treatment, the most frequent cause of death was liver failure. Though there were no differences in recurrence-free survival after curative therapy (median, 60 versus 56 months; P = 0.303), NASH patients had longer overall survival (OS) (median not reached versus 52 months; P = 0.009) independent of other clinicopathologic factors and type of curative treatment.
  
  
  CONCLUSIONS
  Patients with HCC in the setting of NASH have less severe liver dysfunction at HCC diagnosis and better OS after curative treatment compared to counterparts with HCV and/or alcoholic liver disease.
authors.affiliation: Departments of Surgery, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. reddysk@upmc.edu
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: Hui-Wei
authors.initials: HW
authors.lastname: Chen
authors.forename: David J
authors.initials: DJ
authors.lastname: DeMateo
authors.forename: Jon
authors.initials: J
authors.lastname: Cardinal
authors.forename: Jaideep
authors.initials: J
authors.lastname: Behari
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012189:Retrospective Studies; D016896:Treatment Outcome