Award: Presidential Poster Award
Aakash Desai, MD1, Patrick Twohig, MD, MPH1, Sonia Sandhu, MD2, Dalbir S. Sandhu, MD3
1MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; 2Cleveland Clinic Foundation / Akron General, Akron, OH; 3Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH
Introduction: Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related death in the United States. HCC is historically associated with cirrhosis from Hepatitis B virus, Hepatitis C virus (HCV), and alcohol abuse. Nonalcoholic fatty liver disease (NAFLD) is a key risk factor for the development of HCC. The prevalence of obesity and metabolic syndrome in the United States has likely contributed to the HCC epidemic. Epidemiological data reports that two-thirds of obese people have fatty liver ranging from steatosis to steatohepatitis, which in turn can progress to cirrhosis in 3-15% and eventually to HCC. The primary aim of our study is to ascertain the differences between cirrhotic and non-cirrhotic NASH-HCC patients based on demographics, risk factors, and laboratory abnormalities. Additionally, we wanted to quantify the risk factors that increase the likelihood of HCC in NASH patients.
Methods: We performed a retrospective analysis in the IBM Explorys database which has 63781930 unique patient data in the US. Data is reported as counts and percentages and an independent two sample t-test was used to compare epidemiological, clinical and laboratory features between cirrhotic and non-cirrhotic NASH-HCC. Odds ratios were calculated to determine the relationship between NASH-HCC sub-groups and risk factors and converted into Forest plots.
Results: There were 1120 cases of NASH-HCC of which 1040 were cirrhotic and 80 were non-cirrhotic. Patients with cirrhotic NASH-HCC were more likely to have type 2 diabetes mellitus, chronic kidney disease, coronary artery disease, and elevated alpha fetoprotein, direct bilirubin and INR compared to their non-cirrhotic counterpart. Patients with type 2 diabetes (OR 70, 95%CI 59.4-82.5) had the highest risk for HCC in cirrhotic NASH. Patients with elevated ferritin (OR 25, 95%CI 15.1-41.5) had the highest risk for HCC in non-cirrhotic NASH.
Discussion: Patients with type 2 diabetes are at the highest risk for HCC in NASH cirrhosis patients compared to other components of metabolic syndrome. Elevated ferritin levels conferred the highest risk for development of NASH-HCC in non-cirrhotic patients. OSA has been shown to promote HCC in early studies and our findings demonstrate similar but notable risk in both sub-groups. Identifying key differences in the epidemiology and disease traits of cirrhotic and non-cirrhotic NASH-HCC could be used to assist with the early identification of patients that are at risk for HCC
Citation: Aakash Desai, MD; Patrick Twohig, MD, MPH; Sonia Sandhu, MD; Dalbir S. Sandhu, MD. P1553 - QUANTIFYING RISK FACTORS AND COMPARING CLINICAL PARAMETERS FOR CIRRHOTIC AND NON-CIRRHOTIC HEPATOCELLULAR CARCINOMA (HCC) IN NON-ALCOHOLIC STEATOHEPATITIS (NASH). Program No. P1553. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.