With limited data available on the risk of hepatocellular cancer (HCC) in patients with non-alcoholic fatty liver disease (NAFLD), Fasiha Kanwal, MD, MSHS, and colleagues conducted a study to estimate the risk of incident HCC among patients with NAFLD.

For the study, published in Gastroenterology, Dr. Kanwal and colleagues conducted a retrospective review of patients with NAFLD diagnosed between January 1, 2004 and December 31, 2008 who were followed until HCC diagnosis, death, or December 31, 2015. The research team compared risk for HCC in nearly 300,000 patients with NAFLD with that of age- and gender-matched controls who were seen during the same period.

During 2,382,289 person-years (PYs) of follow-up, 490 patients with NAFLD developed HCC (0.21/1,000 PYs), a significantly higher incidence rate when compared with controls (0.02/1,000 PYs). Among patients with NAFLD, those with cirrhosis had the highest annual incidence of HCC (10.6/1,000 PYs). Among patients with NAFLD cirrhosis, HCC risk ranged from 1.6 to 23.7 per 1,000 PYs based on other demographic characteristics. . “Although HCC occurred in NAFLD patients without cirrhosis, the absolute risk was low in this patient population,” adds Dr. Kanwal

Dr. Kanwal notes that research is needed to identify patients with NAFLD who develop HCC in the absence of cirrhosis. “We need accurate risk stratification tools that can be easily applied in routine clinical practice across different populations and healthcare settings,” she explains. In the meantime, she recommends that patients with NAFLD cirrhosis be enrolled in HCC screening programs, while those with NAFLD but no cirrhosis be followed for NAFLD as per clinical practice guidelines.