Risk factors for hepatocellular carcinoma in cirrhosis due to nonalcoholic fatty liver disease: A multicenter, case-control study.
OBJECTIVE
To identify risk factors associated with hepatocellular carcinoma (HCC), describe tumor characteristics and treatments pursed for a cohort of individuals with nonalcoholic steatohepatitis (NASH) cirrhosis.


METHODS
We conducted a retrospective case-control study of a well-characterized cohort of patients among five liver transplant centers with NASH cirrhosis with (cases) and without HCC (controls).


RESULTS
Ninety-four cases and 150 controls were included. Cases were significantly more likely to be male than controls (67%vs45%,P< 0.001) and of older age (61.9 yearsvs58 years,P= 0.002). In addition, cases were more likely to have had complications of end stage liver disease (83%vs71%,P= 0.032). On multivariate analysis, the strongest association with the presence of HCC were male gender (OR 4.3, 95%CI: 1.83-10.3,P= 0.001) and age (OR = 1.082, 95%CI: 1.03-1.13,P= 0.001). Hispanic ethnicity was associated with a decreased prevalence of HCC (OR = 0.3, 95%CI: 0.09-0.994,P= 0.048). HCC was predominantly in the form of a single lesion with regional lymph node(s) and distant metastasis in only 2.6% and 6.3%, respectively. Fifty-nine point three percent of individuals with HCC underwent locoregional therapy and 61.5% underwent liver transplantation for HCC.


CONCLUSIONS
Male gender, increased age and non-Hispanic ethnicity are associated with HCC in NASH cirrhosis. NASH cirrhosis associated HCC in this cohort was characterized by early stage disease at diagnosis and treatment with locoregional therapy and transplant.
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Kathleen E
KE
Corey
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Samer
S
Gawrieh
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Andrew S
AS
deLemos
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Hui
H
Zheng
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Andrew E
AE
Scanga
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Jennifer W
JW
Haglund
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Jorge
J
Sanchez
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Christopher J
CJ
Danford
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Megan
M
Comerford
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Krista
K
Bossi
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Samina
S
Munir
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Naga
N
Chalasani
Kathleen E Corey, Hui Zheng, Jorge Sanchez, Christopher J Danford, Megan Comerford, Krista Bossi, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States.
Julia
J
Wattacheril
Cirrhosis, Gender; Ethnicity; Hepatocellular carcinoma; Nonalcoholic fatty liver disease