Table 2.
Prevalence of NAFLD-HCC in non-cirrhotic patients.
| Author | Publication year | Study Population/Follow-UP Period | Incidence of HCC in Non-Cirrhotic Patients | Characteristics of HCC in Non-Cirrhotic Patients |
|---|---|---|---|---|
| Guzman et al. [30] | 2008 | 50 HCC patients underwent explant treatment or liver resection/2004–2007 | 3 cases/5 NAFLD+5 CC cases lacked cirrhosis. | |
| Paradis et al. [31] | 2009 | 128 surgically resected HCC patients/1995–2007 | 31 cases with MS were non-cirrhotic. | Some HCCs with MS arose via malignant transformation of a pre-existing liver cell adenoma. |
| Kawada et al. [13] | 2009 | 1168 surgically resected HCC patients/1990–2006 | 8 cases (1%) were NASH, 6 were non-cirrhotic. | |
| Yasui et al. [32] | 2011 | 87 NASH-HCC patients/1993–2010 | F1-3; 43 cases | Liver cirrhosis was less common in males. |
| Ertle et al. [33] | 2011 | 162 NAFLD/NASH-HCC patients/2007–2008 | Non-cirrhotic 41.7%, | |
| Dyson et al. [34] | 2014 | 632 HCC patients/2000–2010 | Non-cirrhotic 31/136 (22.8%). | NAFLD-HCC was associated with a lower prevalence of cirrhosis (77.2%). |
| Perumpail et al. [35] | 2015 | 44 HCC patients/2010–2012 | Non-cirrhotic: 6 cases | |
| Mittal et al. [36] | 2016 | 1500 HCC patients/2005–2010 | Non-cirrhotic: 13% | |
| Mohamad et al. [37] | 2016 | 83 NAFLD-HCC patients/2003–2012 | Non-cirrhotic: 36 cases | HCC patients that were non-cirrhotic (compared to cirrhotic) were older (67.5 ± 12.3 vs. 62.7 ± 8.1 years); less likely to be obese (52 vs. 83%) or to have type 2 diabetes (38 vs. 8%); more likely to have single nodules (80.6 vs. 52.2%) of larger size (>5 cm) (77.8 vs. 10.6%); more likely to undergo hepatic resection (66.7% vs. 17%); and less likely to receive loco-regional therapy (22.3 vs. 61.7%) or DDLT (0 vs. 72.3%) |
| Gawrieh et al. [38] | 2019 | 5144 HCC patients/2000–2014 | 11.7% were non-cirrhotic; of whom 26.3% had NAFLD | Older age, more commonly female, less frequently black. Larger tumors, less frequently fulfilled the Milan criteria, more frequently underwent resection, and experienced better overall survival than liver cirrhosis patients. |
| Bengtsson et al. [14] | 2019 | 1562 HCC patients/2004–2017 | NAFLD-HCC 225 patients 26.3% (14.4%), of whom 83 (37%) were non-cirrhotic | Older age, a lower prevalence of diabetes, and more frequent resection.Mortality was similar to that from liver cirrhosis. |
| Kodama et al. [39] | 2019 | 104 NAFLD-HCC patients/2000–2016 | F0-2; 35 cases F3-4; 69 cases |
HCCs in non-cirrhotic patients were larger than in others and evidenced lower histological activity. The recurrence rate was significantly lower in NAFLD-HCC patients who were not cirrhotic (p < 0.01). Risk factors for recurrence were the male gender, lower serum albumin levels, and advanced fibrosis. |
| Tobari et al. [40] | 2020 | 857 NAFLD patients/1991–2018 | 48 patients with non-cirrhotic and 71 with cirrhotic HCCs | Risk factors for HCC in non-cirrhotic patients were the male gender, light drinking, and a high FIB4 index. |
| Kanwal et al. [41] | 2020 | 271,906 NAFLD patients/2004–2008 | 22,794 developed cirrhosis, and 253 HCC, of whom 64 were non-cirrhotic | The risk of HCC was 6.4-fold higher in patients with diabetes, obesity, dyslipidemia, and hypertension (HR: 6.42, 95% CI: 0.89–46.07). |
CI, confidence interval; DDLT, deceased-donor liver transplantation; FIB-4, Fibrosis-4; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; HR, hazard ratio; HCC, hepatocellular carcinoma; MS, metabolic syndrome; vs., versus.