Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002-2033: the ITA.LI.CA database.
hepatocellular carcinoma
nonalcoholic steatohepatitis
Journal
Gut
ISSN: 1468-3288
Titre abrégé: Gut
Pays: England
ID NLM: 2985108R
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
25
04
2021
accepted:
29
11
2021
pubmed:
23
12
2021
medline:
4
1
2023
entrez:
22
12
2021
Statut:
ppublish
Résumé
Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort. We analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC. MAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002-2003, to 77.3% and 28.9% in 2018-2019, respectively, p<0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumours and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p=0.026, p=0.004) and HCC-related (p<0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p=0.006). The prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.
Sections du résumé
BACKGROUND
Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort.
METHODS
We analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC.
RESULTS
MAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002-2003, to 77.3% and 28.9% in 2018-2019, respectively, p<0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumours and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p=0.026, p=0.004) and HCC-related (p<0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p=0.006).
CONCLUSIONS
The prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.
Identifiants
pubmed: 34933916
pii: gutjnl-2021-324915
doi: 10.1136/gutjnl-2021-324915
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
141-152Investigateurs
Anna Sartori
(A)
Angela Imondi
(A)
Barbara Penzo
(B)
Maurizio Biselli
(M)
Paolo Caraceni
(P)
Francesca Garuti
(F)
Annagiulia Gramenzi
(A)
Andrea Neri
(A)
Davide Ramboldi
(D)
Valentina Santi
(V)
Alessandro Granito
(A)
Luca Muratori
(L)
Fabio Piscaglia
(F)
Vito Sansone
(V)
Francesco Tovoli
(F)
Elton Dajti
(E)
Giovanni Marasco
(G)
Federico Ravaioli
(F)
Alberta Cappelli
(A)
Rita Golfieri
(R)
Cristina Mosconi
(C)
Matteo Renzulli
(M)
Ester Marina Cela
(EM)
Antonio Facciorusso
(A)
Valentina Cacciato
(V)
Edoardo Casagrande
(E)
Alessandro Moscatelli
(A)
Gaia Pellegatta
(G)
Nicoletta de Matthaeis
(N)
Gloria Allegrini
(G)
Valentina Lauria
(V)
Giorgia Ghittoni
(G)
Giorgio Pelecca
(G)
Fabrizio Chegai
(F)
Fabio Coratella
(F)
Mariano Ortenzi
(M)
Elisabetta Biasini
(E)
Andrea Olivani
(A)
Alessandro Inno
(A)
Fabiana Marchetti
(F)
Anita Busacca
(A)
Giuseppe Cabibbo
(G)
Calogero Cammà
(C)
Vincenzo Di Martino
(VD)
Giacomo Emanuele Maria Rizzo
(GE)
Maria Stella Franzè
(MS)
Carlo Saitta
(C)
Assunta Sauchella
(A)
Vittoria Bevilacqua
(V)
Dante Berardinelli
(D)
Alberto Borghi
(A)
Andrea Casadei Gardini
(AC)
Fabio Conti
(F)
Alessandro Cucchetti
(A)
Anna Chiara Dall'Aglio
(AC)
Giorgio Ercolani
(G)
Claudia Campani
(C)
Chiara Di Bonaventura
(CD)
Stefano Gitto
(S)
Pietro Coccoli Antonio Malerba
(PC)
Mario Capasso
(M)
Maria Guarino
(M)
Filippo Oliveri
(F)
Veronica Romagnoli
(V)
Alessandro Di Bucchianico
(A)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.