Clinical Features of Non-alcoholic Fatty Liver Disease in Cryptogenic Hepatocellular Carcinoma

Min Young Rim; Oh Sang Kwon; Minsu Ha; Ju Seung Kim; Kwang Il Ko; Dong Kyu Kim; Pil Kyu Jang; Jung Yoon Han; Pyung Hwa Park; Young Kul Jung; Duck Joo Choi; Yun Soo Kim; Ju Hyun Kim

doi:10.4166/kjg.2014.63.5.292

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Rim, Kwon, Ha, Kim, Ko, Kim, Jang, Han, Park, Jung, Choi, Kim, and Kim: Clinical Features of Non-alcoholic Fatty Liver Disease in Cryptogenic Hepatocellular Carcinoma

Original Article

Korean J Gastroenterol 2014;63(5):292-298.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.5.292

Clinical Features of Non-alcoholic Fatty Liver Disease in Cryptogenic Hepatocellular Carcinoma

Min Young Rim, Oh Sang Kwon, Minsu Ha, Ju Seung Kim, Kwang Il Ko, Dong Kyu Kim, Pil Kyu Jang, Jung Yoon Han, Pyung Hwa Park, Young Kul Jung, Duck Joo Choi, Yun Soo Kim, Ju Hyun Kim

Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to: Oh Sang Kwon, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel: +82-32-460-3778, Fax: +82-32-460-3408, E-mail: kos@gilhospital.com

Received 10 February 2014 Revised 8 March 2014 Accepted 13 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD.

Methods

Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(−), anti-HCV(−), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups.

Results

Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70±11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56±7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs.27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m² vs. 24.1 kg/m², p=0.042) than those in the HBV-HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007).

Conclusions

Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.

Keywords: Cryptogenic, Hepatocellular carcinoma, Metabolic syndrome, Nonalcoholic fatty liver disease

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Table 1.

Baseline Characteristics between Cryptogenic and HBV-associated HCC

	Cryptogenic HCC (n=35)	HBV-associated HCC (n=406)	p-value
Age (yr)^a	70±11	56±9	0.001
Sex, male^b	19 (54)	318 (78)	0.042
AST (IU/mL)^a	104±114	85±128	0.435
ALT (IU/mL)^a	77±128	63±88	0.546
Total bilirubin (mg/dL)^a	1.9±3.6	1.6±2.5	0.615
Albumin (g/dL)^a	3.5±0.7	3.5±0.7	0.722
INR^a	1.19±0.21	1.21±0.27	0.700
Platelet (×10³/mm³)^a	188±94	153±86	0.032
Liver cirrhosis^b	23 (66)	318 (78)	0.087
CTP class, A/B/C^b	15/7/1	210/96/12	0.989

Values are presented as mean±SD, n (%), or n only.

HCC, hepatocellular carcinoma; CTP class, Child-Turcotte-Pugh class.

^a Student's t-test

^b Pearson's chi-square test.

Table 2.

Comparison of Risk Factors of NAFLD between Cryptogenic and HBV-associated HCC

	Cryptogenic HCC (n=35)	HBV-associated HCC (n=406)	p-value
BMI (kg/m²)^a	25.3±3.2	24.1±3.3	0.042
DM^b	13 (37)	77 (19)	0.015
HTN^b	17 (49)	112 (27)	0.051
Total cholesterol (mg/dL)^a	137±44	149±42	0.134
HDL cholesterol (mg/dL)^a	38±15	40±15	0.336
Triglyceride (mg/dL)^a	93±50	94±56	0.914
LDL cholesterol (mg/dL)^a	81±34	90±36	0.191
Metabolic syndrome^b	13 (37)	66 (16)	0.001

Values are presented as mean±SD or n (%).

HCC, hepatocellular carcinoma; DM, diabetes mellitus; HTN, hypertension.

^a Student's t-test

^b Pearson's chi-square test.

Table 3.

Comparisons of Tumor Characteristics between Cryptogenic and HBV-associated HCC

	Cryptogenic HCC (n=35)	HBV-associated HCC (n=406)	p-value
AFP (ng/mL)^a	14,639±49,073	6,063±25,687	0.336
TNM stage^c			0.065
1	11 (31)	192 (47)
2	3 (9)	64 (16)
3	12 (34)	101 (25)
4	9 (26)	49 (12)
1 and 2^b	14 (40)	256 (63)	0.007
3 and 4^b	21 (60)	150 (37)

Values are presented as mean±SD or n (%).

HCC, hepatocellular carcinoma.

^a Student's t-test

^b Pearson's chi-square test.

^c TNM staging system of HCC was followed the American Joint Committee on Cancer TNM classification.

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