Association between non-alcoholic fatty liver disease and cancer incidence rate

Gi-Ae Kim; Han Chu Lee; Jaewon Choe; Min-Ju Kim; Min Jung Lee; Hye-Sook Chang; In Young Bae; Hong-Kyu Kim; Jihyun An; Ju Hyun Shim; Kang Mo Kim; Young-Suk Lim

doi:10.1016/j.jhep.2017.09.012

Association between non-alcoholic fatty liver disease and cancer incidence rate

J Hepatol. 2017 Nov 2:S0168-8278(17)32294-8. doi: 10.1016/j.jhep.2017.09.012. Online ahead of print.

Authors

Gi-Ae Kim¹, Han Chu Lee², Jaewon Choe³, Min-Ju Kim⁴, Min Jung Lee¹, Hye-Sook Chang¹, In Young Bae¹, Hong-Kyu Kim¹, Jihyun An⁵, Ju Hyun Shim⁵, Kang Mo Kim⁵, Young-Suk Lim⁵

Affiliations

¹ Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: hch@amc.seoul.kr.
³ Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: drchoe@hotmail.com.
⁴ Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁵ Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

PMID: 29150142
DOI: 10.1016/j.jhep.2017.09.012

Abstract

Background & aims: Little is known about the association between non-alcoholic fatty liver disease (NAFLD) and cancer development. This study investigated the cancer incidence rates in NAFLD and analysed the association between NAFLD and cancer development.

Methods: This historical cohort study included subjects who were followed up for >1 year after having a heath checkup at a tertiary hospital in Korea from September 1, 2004 to December 31, 2005. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis in the absence of other known liver disease, including alcoholic or viral hepatitis. Cox proportional hazards regression model was conducted to assess the association between NAFLD and cancer development.

Results: Of 25,947 subjects, 8,721 (33.6%) had NAFLD. During the total follow-up of 164,671 person-years (median 7.5 years), the cancer incidence rate of the NAFLD group was higher than that of the non-NAFLD group (782.9 vs. 592.8 per 100,000 person-years; hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.17-1.49; p <0.001). When demographic and metabolic factors were adjusted for, NAFLD showed a strong association with three cancers: hepatocellular carcinoma ([HCC]; HR 16.73; 95% CI 2.09-133.85; p = 0.008), colorectal cancer in males (HR 2.01; 95% CI 1.10-3.68; p = 0.02), and breast cancer in females (HR 1.92; 95% CI 1.15-3.20; p = 0.01). A high NAFLD fibrosis score (NFS) and a high fibrosis-4 (FIB-4) score were associated with the development of all cancers and HCC.

Conclusion: NAFLD was associated with the development of HCC, colorectal cancer in males, and breast cancer in females. A high NFS and a high FIB-4 score showed a strong association with the development of all cancers and HCC.

Lay summary: Non-alcoholic fatty liver disease (NAFLD) is associated with developing hepatocellular carcinoma (HCC). There have been limited data on the association between NAFLD and extrahepatic cancers. This study demonstrated that patients with NAFLD showed a higher association with the development of HCC, colorectal cancer in males, and breast cancer in females. A high NAFLD fibrosis score and a high fibrosis-4 score showed a strong association with the development of all cancers and HCC.

Keywords: Cancer; Incidence rate; Noninvasive fibrosis score.