NAFLD is the leading cause of liver cancer in older Americans

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of hepatocellular carcinoma (HCC), the most common type of liver cancer, in older people with Medicare coverage, according to findings published in Clinical gastroenterology and hepatology. Compared with people with hepatitis C-related liver cancer, those with NAFLD had moderately worse survival.

Resulting from fatty accumulation in the liver, NAFLD and its most severe form, non-alcoholic steatohepatitis (NASH), are responsible for an increasing proportion of advanced liver disease worldwide. Due to inflammation, NAFLD can lead to the buildup of scar tissue (fibrosis), cirrhosis (advanced scarring), and even liver cancer. In the absence of approved medical therapies, disease management depends on lifestyle changes such as weight loss and exercise.

The main causes of liver cancer are changing now that Hepatitis B can be prevented by a vaccine and Hepatitis C can be easily treated. The contribution of NAFLD as a cause of liver cancer and its association with tumor stage and overall survival are uncertain.

Ju Dong Yang, MD, of Cedars-Sinai Medical Center, Los Angeles, and colleagues assessed the burden of NAFLD-related liver cancer and its links to clinical outcomes.

Using a study population identified from the Surveillance, Epidemiology and End Results–Medicare database between 2011 and 2015, researchers identified different factors related to liver cancer and its treatment. Of the 5098 people with hepatocellular carcinoma, NAFLD was the leading cause, accounting for 1813 cases (36%).

Compared to people with hepatitis C-related liver cancer, people with NAFLD were less likely to be monitored for liver cancer, less likely to be diagnosed with HCC at a stage early and had a slightly lower overall survival.

A subgroup analysis of people with NAFLD-related liver cancer found that early-stage cancer, absence of severe liver disease (indicated by ascites or hepatic encephalopathy), and curative treatment were associated with improved survival. People with both NAFLD and another type of liver disease were more likely to be monitored, diagnosed early, and received treatment, resulting in better overall survival per compared to people with NAFLD alone.

“NAFLD is the leading etiology of HCC among Medicare beneficiaries,” the researchers wrote. “Compared to other etiologies, NAFLD was associated with poorer HCC surveillance reception, earlier detection, and slightly poorer survival. Multifaceted interventions to improve surveillance utilization are needed to improve the prognosis of patients with NAFLD-related HCC.

Click here to read the summary of the study in Clinical gastroenterology and hepatology.

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