title: Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team.
abstract: OBJECTIVE
  Hepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis.
  
  
  METHODS
  Following the introduction of centralised specialist teams to manage patients with cancer in England, we characterised the demographics of patients with HCC referred to the Newcastle-upon-Tyne Hospitals NHS Foundation Trust between 2000 and 2010. Regional HCC mortality data was from Public Health England.
  
  
  RESULTS
  HCC related mortality in the region rose 1.8 fold in 10 years, from 2.0 to 3.7 per 100,000. 632 cases were reviewed centrally, with 2-3 fold increases in referrals of patients with associated hepatitis C, alcoholic liver disease or no chronic liver disease and a >10 fold increase in HCC associated with non-alcoholic fatty liver disease (NAFLD). By 2010 NAFLD accounted for 41/118 (34.8%) cases. Irrespective of associated etiologies, metabolic risk factors were present in 78/118 (66.1%) cases in 2010, associated with regional increases in obesity and diabetes. Median overall survival was just 10.7 months. Although patients with NAFLD associated HCC were older (71.3 yr vs. 67.1 yr; p<0.001) and their cancers less often detected by surveillance, their survival was similar to other etiologies. This was attributed to significantly higher incidental presentation (38.2%) and lower prevalence of cirrhosis (77.2%).
  
  
  CONCLUSIONS
  HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most of the cases is poor, but older patients with co-morbidities can do well, managed, within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Jessica
authors: J
authors: Dyson
authors: Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Bryan
authors: B
authors: Jaques
authors: Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
authors: Dipankar
authors: D
authors: Chattopadyhay
authors: Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Rajiv
authors: R
authors: Lochan
authors: Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Janine
authors: J
authors: Graham
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Debasish
authors: D
authors: Das
authors: Department of Radiology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Tahira
authors: T
authors: Aslam
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Imran
authors: I
authors: Patanwala
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Sameer
authors: S
authors: Gaggar
authors: Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
authors: Michael
authors: M
authors: Cole
authors: Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Kate
authors: K
authors: Sumpter
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Centre for Liver Disease, Mater Miscericordiae University Hospital, Dublin, Ireland.
authors: Stephen
authors: S
authors: Stewart
authors: Department of Radiology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: John
authors: J
authors: Rose
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Mark
authors: M
authors: Hudson
authors: Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
authors: Derek
authors: D
authors: Manas
authors: The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK. Electronic address: H.L.Reeves@ncl.ac.uk.
authors: Helen L
authors: HL
authors: Reeves
mesh_terms: D000367:Age Factors; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005234:Fatty Liver / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications*; D012307:Risk Factors
keywords: AIH; ALD; BCLC; BSC; Barcelona Clinic for Liver Cancer; CLD; HBV; HCC; HCV; HPB; Hepatocellular cancer; MDM; Multidisciplinary team; NAFLD; Non-alcoholic fatty liver disease; OLTx; Obesity; PBC; Type 2 diabetes; alcoholic liver disease; autoimmune hepatitis; best supportive care; chronic liver disease; hepatitis B; hepatitis C; hepatocellular cancer; hepatopancreatobiliary; multidisciplinary meeting; non-alcoholic fatty liver disease; orthotopic liver transplant; primary biliary cirrhosis