Meta-analysis of 111 patients with nonalcoholic steatohepatitis-associated hepatocellular carcinoma

Objective To summarize the clinical features of patients with nonalcoholic steatohepatitis (NASH) -associated hepatacellular carcinoma (HCC) .Methods Systematic analysis of clinical data of 111 patients with NASH-associated HCC from 22 studies published from 1990 to 2010 by searching Pubmed, Medline, OVID databases.Results 69 patients were male (62%) .Mean age at onset of abnormal liver function test and diagnosis of NASH and HCC was respectively 60, 63.9 and 66.7 years.Most patients were obese (79%) and diabetic (78%) , 33% of patients had dyslipidemia and 52% had hypertension.98.6% (71/72) of cases complicated with at least one metabolic disease.71% of patients had a single nodule, the tumors ranged from 1.0 to 13 cm in diameter (mean, 3.3 cm) and often showed well to moderately-differentiated HCC with steatosis and Mallory bodies.Most nodules located in the right lobe of liver.33% of cases showed non-cirrhosis in non-cancerous areas.Most patients had no abnormal clinical manifestations but found tumor by routine health examination.65% of cases exhibited elevation of AFP and/or PIVKAII.51% (38/74) of cases underwent hepatectomy, 25% (19/74) received liver transplantation.During the mean follow-up of 24 months, 21% of patients died (11/51) , 15% recurred.Conclusion NASH-associated HCC was common in male.These patients were usually accompanied by metabolic diseases.Although most patients had good tumor differentiation and high radical resection rate, they might not find tumor until late stage, which caused relatively poor prognosis because of indolent progressive course of NASH.Regular screening for HCC is necessary for NASH patients, especially the elderly men with multiple metabolic disorders.