Characteristics of HCC from non-alcoholic fatty liver disease compared to HCC from other causes

By Matthew Stenger

Posted: 03/22/2022 10:50:00 AM

Last update: 03/22/2022 12:02:27

In a meta-analysis published in The Lancet Oncology, Tan et al found that patients with hepatocellular carcinoma (HCC) related to non-alcoholic fatty liver disease (NAFLD) were more likely to have metabolic/cardiovascular comorbidity, less likely to have cirrhosis, and less likely to have under surveillance before diagnosis compared to patients with HCC from other causes. Treatments received and overall survival did not differ.

Study details

The analysis included 61 studies in English conducted between January 1980 and May 2021, including a total of 94,636 patients with HCC. Of these, 15,377 (15.1%) had NAFLD-related HCC.

Main conclusions

Compared to patients with HCC from other causes, those with NAFLD-related HCC:

  • Were older (mean difference = 5.62 years, P
  • had a higher body mass index (mean difference = 2.99 kg/m², P
  • Were more likely to have metabolic comorbidities, including diabetes (odds ratio [OR] = 4.31, P P P P = .0055)
  • Were more likely to be non-cirrhotic (38.5% vs. 4.6%, OR=3.71, P

Patients with NAFLD-related HCC had larger tumor diameters (mean difference = 0.67 cm, p.0087) and were more likely to have uninodular lesions (OR = 1.36, P = .0003). No differences between groups were observed in Barcelona clinic liver cancer stages, TNM stages, alpha-fetoprotein concentration, or Eastern Cooperative Oncology Group performance status.

Patients with NAFLD-related HCC were less likely to be monitored prior to diagnosis (32.8% vs. 55.7%, OR=0.36, P P = 0.43). Patients with NAFLD-related HCC had better disease-free survival (HR = 0.79, 95% CI = 0.63 to 0.99, P = 0.044).

The researchers concluded, “NAFLD-related HCC is associated with a higher proportion of patients without cirrhosis and lower surveillance rates than HCC due to other causes. Surveillance strategies should be developed for patients with NAFLD without cirrhosis who are at high risk of developing HCC.

Daniel Q. Huang, MBBS, MRCPfrom Yong Loo Lin School of Medicine, National University of Singaporeis the corresponding author for The Lancet Oncology item.

Disclosure: The researchers reported no external funding for the study. For full disclosures from the study authors, visit

The content of this article has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the views and opinions of ASCO®.

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