VIENNA – Nonalcoholic fatty liver disease (NAFLD) now stands as the second most common cause of U.S. cases of hepatocellular carcinoma, and with highly effective drug regimens now sharply dropping the prevalence of hepatitis C virus infection, NAFLD – a complication of obesity – is poised to snag the top spot, Dr. Zobair Younossi said in a video interview at the meeting sponsored by the European Association for the Study of the Liver.
In an analysis that combined U.S. national cancer registry data collected by the National Cancer Institute and morbidity diagnostic codes collected by Medicare, Dr. Younossi calculated that, during 2004-2009 among U.S. adults covered by Medicare, 24% of patients newly diagnosed with hepatocellular carcinoma (HCC) had NAFLD as their pre-existing chronic liver disease, compared with 48% who had hepatitis C virus infection as their trigger. The third most common cause of HCC was alcoholic liver disease (14%), followed by hepatitis B virus infection (8%).
Dr. Younossi’s analysis also included survival data for each HCC case in the first year following diagnosis, which showed that NAFLD-associated cases also were deadlier, linking with a statistically significant 20% increase in mortality compared with HCC associated with other causes. Quicker lethality of NAFLD-linked HCC is probably due to the more advanced stage at diagnosis, he said.
The findings highlight the need for improved surveillance in these patients, a process complicated by the challenge of imaging the liver in obese patients, said Dr. Younossi, chairman of medicine and head of the Center for Liver Diseases at Inova Fairfax Hospital in Falls Church, Va.
Dr. Younossi has been a consultant to Gilead, Abbvie, Bristol-Myers Squibb, GlaxoSmithKline, Intercept, and Salix.