Article

Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma cause by chronic hepatitis C

Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Journal of Gastroenterology (Impact Factor: 4.02). 04/2010; 45(9):960-7. DOI: 10.1007/s00535-010-0237-1
Source: PubMed

ABSTRACT This study was performed to clarify the outcomes and recurrence of hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) in comparison with the data for HCC caused by hepatitis C virus (HCV) infection.
Data for 34 NASH patients with HCC (NASH-HCC) were analyzed prospectively, and data for 56 age- and sex-matched patients with HCC due to HCV chronic liver disease (HCV-HCC) were collected retrospectively. After the initial treatment for HCC, patients were followed regularly at least every 4 months by performing clinical examinations, serum liver function tests, monitoring alpha-fetoprotein and des-gamma-carboxy prothrombin, and utilizing various imaging modalities.
The five-year survival rate was 55.2% and the cumulative recurrence of HCC at 5 years was 69.8% in treated cases of NASH-HCC. The NASH-HCC and HCV-HCC groups showed similar survival and recurrence rates. Of the 16 NASH-HCC patients curatively treated, recurrence was detected more than 2 years after the initial treatment in 9. Three patients showed intrahepatic recurrences away from the initial HCC, and 3 patients showed a change in tumor marker production after treatment of the initial HCC. The size of the HCC and the stage of fibrosis were significant risk factors for HCC recurrence in NASH-HCC.
HCC recurrence was very high in NASH, and the HCC may be of multicentric origin, similar to HCC based on viral hepatitis. Regular screening for HCC is extremely important for NASH patients with HCC, even after curative treatment. This study confirmed that NASH-HCC has a similar course to that of HCV-HCC.

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    • "Firstly, in this study, more than half of our patients had evidence of hepatitis B infection. This feature is distinctly different from countries where hepatitis C infection and NAFLD were the predominant etiologies of chronic liver disease [34]. Secondly, patients with hepatitis B or C might have received anti-viral treatment to suppress viral activity some time during the follow-up period, and this may alter the prognosis [35], [36]. "
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    • "Single nodular presentation may be related to a lower tendency of portal vein invasion and, subsequently, less intrahepatic metastasis. Additionally, no significant difference was noted in Child Pugh classes, tumor stages, and overall survival rates between the cryptogenic HCC patients and the other HCC patients, a finding partially concordant with other reports [29-31]. In recent studies, patients with cryptogenic HCC had a higher survival rate than those with HCV-HCC and/or ALC-HCC after curative treatment [29,30]. "
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    • "Tokushige et al. [18] "
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