CLEVELAND — While it is well-understood that both nonalcoholic fatty liver disease (NAFLD) and hepatitis C virus (HCV) infection commonly result in hepatic fibrosis and might lead to cirrhosis, it has not been clear whether advanced fibrosis, determined by measurements of liver stiffness, increases the incidence of hepatocellular carcinoma in veterans.
That was the issue addressed in a study led by the VA Northeast Ohio Healthcare System and Case Western Reserve University School of Medicine, both in Cleveland. Results were published by PLoS One.1
The study team used the VA Informatics and Computing Infrastructure (VINCI) to create a nationwide cohort of patients with an existing diagnosis of HCV or NAFLD with liver transient elastography (TE) testing from 2015 to 2019. The researchers identified and validated HCC cases, along with a random sample of non-HCC patients, to calculate incidence rates for HCC after adjustment for confounders. At the time of the testing, 26,161 patients had been diagnosed with HCV and 13,629 were diagnosed with NAFLD.
Results indicated that, in patients with HCV, rates of HCC increased with liver stiffness with incidences of 0.28 (95% CI 0.24, 0.34), 0.93 (95% CI 0.72, 1.17), 1.28 (95% CI 0.89, 1.79), and 2.79 (95% CI 2.47, 3.14)/100,000 person years for TE score ranges <9.5 kPa, 9.5-12.5 kPa, 12.5-14.5 kPa and >14.5 kPa, respectively, after a median follow-up of 2.3 years. “HCC incidence also increased with higher TE liver stiffness measures in NAFLD after a median follow-up of 1.1 years,” the authors added.
“In this retrospective cohort, the incidence of HCC in HCV and NAFLD increases with higher TE liver stiffness measures, confirming that advanced fibrosis portends risk in viral and non-viral fibrotic liver diseases,” according to the researchers. “Additional comparative studies are needed to determine the optimal cut point of TE liver stiffness to inform HCC screening guidelines and approaches.”
- Davitkov P, Hoffman K, Falck-Ytter Y, Wilson B, Stojadinovikj G, Anthony DD, Cohen SM, Cooper G. Increasing liver stiffness is associated with higher incidence of hepatocellular carcinoma in hepatitis C infection and non-alcoholic fatty liver disease-A population-based study. PLoS One. 2023 Jan 24;18(1):e0280647. doi: 10.1371/journal.pone.0280647. PMID: 36693057; PMCID: PMC9873178.