I.Y.LIEW1, X.Y.LOO1, K.SIM1, W.Y.LIM2, L.H.HTET2, A.CHOW2, Y.K.CHOW2
MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2
Non-Alcoholic Fatty Liver disease (NAFLD), one of the most common causes of liver disease globally, has its well-known complications such as ischaemic related disease and liver cirrhosis. Hepatocellular carcinoma (HCC) in NAFLD subjects is less well-studied. This study aims to identify factors influencing liver associated complications in a local NAFLD cohort.
We performed a retrospective observational review on 3192 NAFLD patients at our institution from 2007 to 2017 with DSRB approval. Patient demographics, comorbidities and imaging were analysed to associate with the liver fibrosis progression and HCC.
Over a 10-year period, the baseline demographics included 1605 males and 1587 females. Of which 75.6% were Chinese, 8.7% Malay, 8.5% Indian, and 7.2% were of other races. The median Charlson score was 1. 33 patients (1%) developed HCC and 97 (3%) had features of portal hypertension. Baseline age, diabetes, hypertension and Charlson scores were significantly associated with an increased risk of HCC. This association was not seen in high Body Mass Index (BMI) and metabolic syndrome groups, contradicting previously published data. Portal hypertension features (ascites and splenomegaly) were more seen in older and obese patients. Baseline NAFLD and metabolic conditions did not predict liver fibrosis progression.
Despite the standard theories of HCC carcinogenesis from fibrinogenesis, an association of metabolic disorders at baseline along with HCC development without a need for liver fibrinogenesis reflects a potential alternative oncogenic pathway for HCC development. We conclude that there is an emerging need for the better characterisation of HCC risk for the silent epidemic of NAFLD.