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J Hepatol. 2014 Jan;60(1):110-7. doi: 10.1016/j.jhep.2013.08.011. Epub 2013 Aug 23.

Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team.

Author information

  • 1The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
  • 2Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
  • 3Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
  • 4Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
  • 5Department of Radiology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
  • 6Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
  • 7Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
  • 8The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Centre for Liver Disease, Mater Miscericordiae University Hospital, Dublin, Ireland.
  • 9The Liver Group, Department of Medicine, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Hepatopancreatobiliary Team, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK. Electronic address: H.L.Reeves@ncl.ac.uk.

Abstract

BACKGROUND & AIMS:

Hepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis.

METHODS:

Following the introduction of centralised specialist teams to manage patients with cancer in England, we characterised the demographics of patients with HCC referred to the Newcastle-upon-Tyne Hospitals NHS Foundation Trust between 2000 and 2010. Regional HCC mortality data was from Public Health England.

RESULTS:

HCC related mortality in the region rose 1.8 fold in 10 years, from 2.0 to 3.7 per 100,000. 632 cases were reviewed centrally, with 2-3 fold increases in referrals of patients with associated hepatitis C, alcoholic liver disease or no chronic liver disease and a >10 fold increase in HCC associated with non-alcoholic fatty liver disease (NAFLD). By 2010 NAFLD accounted for 41/118 (34.8%) cases. Irrespective of associated etiologies, metabolic risk factors were present in 78/118 (66.1%) cases in 2010, associated with regional increases in obesity and diabetes. Median overall survival was just 10.7 months. Although patients with NAFLD associated HCC were older (71.3 yr vs. 67.1 yr; p<0.001) and their cancers less often detected by surveillance, their survival was similar to other etiologies. This was attributed to significantly higher incidental presentation (38.2%) and lower prevalence of cirrhosis (77.2%).

CONCLUSIONS:

HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most of the cases is poor, but older patients with co-morbidities can do well, managed, within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.

Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

KEYWORDS:

AIH; ALD; BCLC; BSC; Barcelona Clinic for Liver Cancer; CLD; HBV; HCC; HCV; HPB; Hepatocellular cancer; MDM; Multidisciplinary team; NAFLD; Non-alcoholic fatty liver disease; OLTx; Obesity; PBC; Type 2 diabetes; alcoholic liver disease; autoimmune hepatitis; best supportive care; chronic liver disease; hepatitis B; hepatitis C; hepatocellular cancer; hepatopancreatobiliary; multidisciplinary meeting; non-alcoholic fatty liver disease; orthotopic liver transplant; primary biliary cirrhosis

PMID:
23978719
[PubMed - indexed for MEDLINE]
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