title: Comparing clinical presentations, treatments and outcomes of hepatocellular carcinoma due to hepatitis C and non-alcoholic fatty liver disease.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is increasing in incidence in the UK and globally. Liver cirrhosis is the common cause for developing HCC. The common reasons for liver cirrhosis are viral hepatitis C (HCV), viral hepatitis B and alcohol. However, HCC caused by non-alcoholic fatty liver disease (NAFLD)-cirrhosis is now increasingly as a result of rising worldwide obesity.
  
  
  OBJECTIVE
  : To compare the clinical presentation, treatment options and outcomes of HCC due to HCV and NAFLD patients.
  
  
  METHODS
  Data were collected from two liver transplant centres in the UK (Birmingham and Newcastle upon Tyne) between 2000 and 2014. We compared 275 patients with HCV-related HCC against 212 patients with NAFLD- related HCC.
  
  
  RESULTS
  Patients in the NAFLD group were found to be significantly older ( P < 0.001) and more likely to be Caucasian ( P < 0.001). They had lower rates of cirrhosis ( P < 0.001) than those in HCV-HCC group. The NAFLD group presented with significantly larger tumours ( P = 0.009), whilst HCV patients had a higher alpha fetoprotein ( P = 0.018). NAFLD patients were more commonly treated with TACE ( P = 0.005) than the HCV patients, whilst the HCV group were significantly more likely to be transplanted ( P < 0.001). In patients selected for liver transplantation, 5-year survival rates in NAFLD were not significantly different from HCV-HCC (44 and 56% respectively, P = 0.102).
  
  
  CONCLUSIONS
  In this study, NAFLD patients presented with larger tumours that were less likely to be amenable to curative therapy, as compared with HCV patients. Despite this disadvantage, patients with NAFLD had similar overall survival compared to patients with HCV.
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Nwe Ni
authors.initials: NN
authors.lastname: Than
authors.affiliation: Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK.
authors.forename: Anwar
authors.initials: A
authors.lastname: Ghazanfar
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Tehami
authors.affiliation: National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Coldham
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.affiliation: Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Manas
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Shah
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Newsome
authors.affiliation: Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Reeves
authors.affiliation: From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Shishir
authors.initials: S
authors.lastname: Shetty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome