Non-alcoholic steatohepatitis (NASH) associated hepatocellular carcinomas (NASH-HCC) are on the rise. NASH-HCC has often been seen to develop in the fibrotic liver. There is conflicting data on the outcome of non-cirrhotic NASH-HCC. Additionally, type 2 diabetes (T2D) is also considered to be associated with poor survival.

Therefore, a study was conducted to explore the oncological outcomes of non-cirrhotic NASH-HCC and the influence of T2D.

Patients with non-cirrhotic NASH-HCC with T2D were matched for risks factors for poor outcome, such as age, gender, body mass index, with patients with NASH-HCC without T2D. The patients were then matched 1:1 with HCCs of other underlying liver diseases, both with and without T2D. Investigators assessed the oncological outcomes using Kaplan-Meier curves.

Among 365 HCCs resected from 2001 to 2017, 34 patients with non-cirrhotic NASH-HCC, 17 each with and without T2D, were included and matched with 26 patients with hepatitis-HCC and 28 patients with alcohol-related HCC. Oncological risk factors including tumor size, resection margin, and vessel invasion were comparable. No difference was seen in overall survival. There was a 5-year survival of 71.3% for NASH-HCC, 60.4% for hepatitis-HCC, 79.9% for alcohol-HCC. It was noted that NASH-HCC was tied to longer disease-specific survival in comparison with hepatitis-HCC (5-year 87.5% vs. 63.7%), though the recurrence-free survival was similar. T2D did not affect the oncological outcomes in either liver disease.

The researchers thus concluded that the outcomes of non-cirrhotic NASH-HCC were comparable to other underlying etiologies. Patients with non-cirrhotic NASH-HCC appeared to have the same risks of HCC recurrence as did patients with cirrhotic liver disease of other etiologies.

 Source: Billeter AT, Müller PC, Albrecht T, et al. Impact of Type 2 Diabetes on Oncologic Outcomes of Hepatocellular Carcinomas in Non-Cirrhotic, Non-alcoholic Steatohepatitis: a Matched-Pair Analysis. J Gastrointest Surg. 2020 May 6.