Original articleSystematic reviews and meta-analysesAssociation Between Nonalcoholic Fatty Liver Disease and Risk for Hepatocellular Cancer, Based on Systematic Review
Section snippets
Methods
We followed published guidelines for the conduct and reporting of systematic reviews.6 We performed a structured keyword search in PubMed to identify original research reports published in print or online in English in peer-reviewed journals between January 1, 1992 and December 31, 2011 that evaluated the association between NAFLD/NASH or CC and HCC either directly (eg, population- and clinic-based cohort studies) or indirectly (eg, cross-sectional and case-control studies and case
Results
Our combined PubMed keyword and review article ancestry searches identified >14,000 citations (study flow diagram, Figure 1). Among the 265 full citations reviewed, the most common reason for exclusion was report did not contain specific results for HCC or did not adequately distinguish HCC attributed to NAFLD/NASH or CC from HCC attributed to other causes (eg, alcohol-related HCC) or other health outcomes (eg, overall liver-related mortality or total mortality). A total of 17 cohort studies,
Discussion
This systematic review shows that despite several limitations, the epidemiologic evidence supports an association between NAFLD/NASH and an increased HCC risk that seems to be predominantly limited to those with cirrhosis. The studies that followed NAFLD or NASH cohorts with either few or no cirrhosis cases at baseline were consistent in showing that NAFLD/NASH was associated with a minimal HCC risk; cumulative HCC mortality rates ranged between 0% and 3% in NAFLD/NASH cohorts, with 5 of 7
Acknowledgments
The authors thank Adrian Rideau, BA, for her administrative assistance.
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Conflicts of interest The authors disclose no conflicts of interest.
Funding This material is based on work supported in part by a VA Clinical Research and Development Merit Review Award (H-22934, principal investigator: H. El-Serag, MD, MPH), the National Institute of Diabetes Digestive and Kidney Diseases (K01 DK078154-03 and K24 DK081736-01, principal investigators, D. White and H. El-Serag, respectively), the Texas Medical Center Digestive Disease Center (P30 Center grant DK56338), and the Houston VA HSR&D Center of Excellence (HFP90-020). The U.S. Department of Veteran Affairs, the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Disease played no role in design, implementation, analysis, interpretation or decision to report these results.