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

Arising from the accumulation of fat in the liver, NAFLD and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for a growing proportion of advanced liver disease worldwide. As a result of inflammation, NAFLD can lead to the buildup of scar tissue (fibrosis), cirrhosis (advanced scarring) and even liver cancer. With no approved medical therapies, disease management is dependent on lifestyle changes such as weight loss and exercise.

The main causes of liver cancer are shifting now that hepatitis B can be prevented with 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 is uncertain.

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

Using a study population identified from the Surveillance, Epidemiology and End Results–Medicare database between 2011 and 2015, the researchers identified different factors linked to liver cancer and its treatment. Of the 5,098 people with hepatocellular carcinoma, NAFLD was the leading cause, accounting for 1,813 cases (36%).

Compared to people with liver cancer related to hepatitis C, those with NAFLD were less likely to undergo liver cancer surveillance, less likely to be diagnosed with HCC at an early stage and had modestly worse overall survival.

A subgroup analysis of people with NAFLD-related liver cancer found that early-stage cancer, absence of severe liver disease (as indicated by ascites or hepatic encephalopathy) and curative treatment were linked to improved survival. People who had both NAFLD and another type of liver disease were more likely to undergo surveillance, be diagnosed early and receive treatment, leading to better overall survival compared with people who had NAFLD alone.

“NAFLD is the leading etiology of HCC among Medicare beneficiaries,” wrote the researchers. “Compared with other etiologies, NAFLD was associated with lower HCC surveillance receipt, early-stage detection and modestly poorer survival. Multifaceted interventions for improving surveillance uptake are needed to improve prognosis of patients with NAFLD-related HCC.”

Click here to read the study abstract in Clinical Gastroenterology and Hepatology.

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