Clin Mol Hepatol.
2019 Mar;25(1):52-64. 10.3350/cmh.2018.0040.
Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B
- Affiliations
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- 1Division of Hepatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. sghwang@cha.ac.kr
- 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
- 4Bio-Age, Medical Research Institute, Seoul, Korea.
- 5Department of Statistics, LSK Global Pharma Services Co., Ltd., Seoul, Korea.
- KMID: 2447251
- DOI: http://doi.org/10.3350/cmh.2018.0040
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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