Clin Mol Hepatol. 2018 Oct 23. doi: 10.3350/cmh.2018.0040. [Epub ahead of print]
Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B.
Lee YB1,2, Ha Y1, Chon YE1, Kim MN1, Lee JH1, Park H1, Kim KI3, Kim SH4,5, Rim KS1, Hwang SG1.
Author information
1
Division of Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
2
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
3
Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
4
Bio-Age, Medical Research Institute, Seoul, Korea.
5
Department of Statistics, LSK Global Pharma Services Co., Ltd., Seoul, Korea.
Abstract
Background/Aims:
Nonalcoholic fatty liver disease (NAFLD) is becoming a worldwide epidemic, and is frequently found in patients with chronic hepatitis B (CHB). We investigated the impact of histologically proven hepatic steatosis on the risk for hepatocellular carcinoma (HCC) in CHB patients without excessive alcohol intake.
Methods:
Consecutive CHB patients who underwent liver biopsy from January 2007 to December 2015 were included. The association between hepatic steatosis (≥ 5%) and subsequent HCC risk was analyzed. Inverse probability weighting (IPW) using the propensity score was applied to adjust for differences in patient characteristics, including metabolic factors.
Results:
Fatty liver was histologically proven in 70 patients (21.8%) among a total of 321 patients. During the median (interquartile range) follow-up of 5.3 (2.9-8.3) years, 17 of 321 patients (5.3%) developed HCC: 8 of 70 patients (11.4%) with fatty liver and 9 of 251 patients (3.6%) without fatty liver. The five-year cumulative incidences of HCC among patients without and with fatty liver were 1.9% and 8.2%, respectively (P=0.004). Coexisting fatty liver was associated with a higher risk for HCC (adjusted hazards ratio [HR], 3.005; 95% confidence interval [CI], 1.122-8.051; P=0.03). After balancing with IPW, HCC incidences were not significantly different between the groups (P=0.19), and the association between fatty liver and HCC was not significant (adjusted HR, 1.709; 95% CI, 0.404-7.228; P=0.47).
Conclusions:
Superimposed NAFLD was associated with a higher HCC risk in CHB patients. However, the association between steatosis per se and HCC risk was not evident after adjustment for metabolic factors.
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