title: Treatment and survival of non-alcoholic steatohepatitis associated hepatocellular carcinoma.
abstract: BACKGROUND
  The incidence of non-alcoholic steatohepatitis (NASH) is increasing worldwide and a poorly defined subset of patients develops end-stage liver disease and hepatocellular carcinoma (HCC). Differences in the biological behaviour, tumour characteristics, associated risk factors, treatment outcomes and overall survival of patients with NASH-HCC remain poorly defined. The aim of this study was to determine and analyze these differences in a large clinical cohort to guide treatment decisions.
  
  
  METHODS
  1119 patients with HCC treated in an 11 year period at the University Medical Centre of the Johannes Gutenberg University Mainz were retrospectively analyzed.
  
  
  RESULTS
  Patients with NASH-HCC (n = 45) were older (67.6 vs. 65 years), had an increased frequency of the metabolic syndrome and complications with a higher incidence of obesity (31.1% vs. 14.7%), type II diabetes mellitus (66.7% vs. 37.85%), a higher rate of myocardial infarction (13.3% vs. 4.8%) and apoplectic stroke (8.9% vs. 2.1%) (all p < 0.05). Interestingly, liver function was preserved to a higher extent and MELD scores were significantly lower in NASH-HCC. Nonetheless, resection or orthotopic liver transplantation was performed only in 17.8% and 4.4% of NASH-HCC respectively. Overall survival was lower compared to HCC of other aetiologies. Independent of the underlying aetiology BMI exhibited a positive correlation with overall survival.
  
  
  CONCLUSIONS
  Despite retained liver function, patients with NASH-associated HCC showed a decreased overall survival. With regards to the expected increasing prevalence of NASH, it will be necessary to improve screening and surveillance strategies to identify HCC in NASH early and improve survival.
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Arndt.Weinmann@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Arndt.Weinmann@unimedizin-mainz.de.|Clinical Registry Unit (CRU), University Medical Center Johannes Gutenberg University, Mainz, Germany. Arndt.Weinmann@unimedizin-mainz.de.
authors.forename: Arndt
authors.initials: A
authors.lastname: Weinmann
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Yvonne.Alt@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Yvonne.Alt@unimedizin-mainz.de.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Alt
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Sandra.Koch@unimedizin-mainz.de.|Clinical Registry Unit (CRU), University Medical Center Johannes Gutenberg University, Mainz, Germany. Sandra.Koch@unimedizin-mainz.de.
authors.forename: Sandra
authors.initials: S
authors.lastname: Koch
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Carina.Nelles@unimedizin-mainz.de.
authors.forename: Carina
authors.initials: C
authors.lastname: Nelles
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Johannes Gutenberg University, Mainz, Germany. dueber@radiologie.klinik.uni-mainz.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany. Hauke.Lang@unimedizin-mainz.de.
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.affiliation: Department of Transplantation and Hepatobiliopancreatic Surgery, University Medical Center Johannes Gutenberg University, Mainz, Germany. Gerd.Otto@unimedizin-mainz.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Tim.Zimmermann@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Tim.Zimmermann@unimedizin-mainz.de.
authors.forename: Tim
authors.initials: T
authors.lastname: Zimmermann
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Jens.Marquardt@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Jens.Marquardt@unimedizin-mainz.de.
authors.forename: Jens U
authors.initials: JU
authors.lastname: Marquardt
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Peter.Galle@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Peter.Galle@unimedizin-mainz.de.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. Marcus-Alexander.Woerns@unimedizin-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. Marcus-Alexander.Woerns@unimedizin-mainz.de.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Wörns
authors.affiliation: Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany. schatten@uni-mainz.de.|Cirrhosis Center Mainz (CCM), University Medical Center Johannes Gutenberg University, Mainz, Germany. schatten@uni-mainz.de.
authors.forename: Jörn M
authors.initials: JM
authors.lastname: Schattenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D009765:Obesity / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome