Risk of development of hepatocellular carcinoma in patients with NASH-related cirrhosis

The risk of development of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is well established and is being recognized increasingly in non-alcoholic steatohepatitis (NASH)-related cirrhosis. This study aimed to assess the risk of development of HCC in patients with NASH-related cirrhosis.

From January 2010 to October 2011, we prospectively enrolled 585 patients with liver cirrhosis (men:women ratio 4.4:1, mean age 50.1 +/- 6.1 years, aetiology HBV 19%, HCV 14.2%, NASH-related 7%, cryptogenic cirrhosis 17.8%, already diagnosed cirrhosis 48.2%, and the remaining were newly diagnosed cases). The cumulative follow-up was for 5.9 +/- 0.5, 6.1 + 0.8 and 6.8 + 1.2 years for HBV, HCV and NASH-related cirrhosis, respectively. Patients with advanced cirrhosis, Child class C and associated comorbid conditions where survival was < 1 year were excluded from the study. The remaining patients were followed up 6-monthly with ultrasound examination and alpha-fetoprotein (AFP) test. Patients suspected of HCC underwent triple-phase computed tomography (CT) scan and liver biopsy was done to confirm the diagnosis.

A total of 54 patients developed HCC, of which 26 had HBV, 14 had HCV, 9 had- cryptogenic and 6 had- NASH-related cirrhosis. The annual rate of development of HCC was 1.5%, 3.6%, 0.6% and 0.46 in HBV, HCV, cryptogenic and NASH-related cirrhosis, respectively.

The incidence of HCC was highest in HCV and lowest in NASH-related cirrhosis. These figures suggest an intermediate risk of development of HCC when compared to western countries and Japan.