Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team

J Hepatol. 2014 Jan;60(1):110-7. doi: 10.1016/j.jhep.2013.08.011. Epub 2013 Aug 23.


Background & aims: Hepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis.

Methods: Following the introduction of centralised specialist teams to manage patients with cancer in England, we characterised the demographics of patients with HCC referred to the Newcastle-upon-Tyne Hospitals NHS Foundation Trust between 2000 and 2010. Regional HCC mortality data was from Public Health England.

Results: HCC related mortality in the region rose 1.8 fold in 10 years, from 2.0 to 3.7 per 100,000. 632 cases were reviewed centrally, with 2-3 fold increases in referrals of patients with associated hepatitis C, alcoholic liver disease or no chronic liver disease and a >10 fold increase in HCC associated with non-alcoholic fatty liver disease (NAFLD). By 2010 NAFLD accounted for 41/118 (34.8%) cases. Irrespective of associated etiologies, metabolic risk factors were present in 78/118 (66.1%) cases in 2010, associated with regional increases in obesity and diabetes. Median overall survival was just 10.7 months. Although patients with NAFLD associated HCC were older (71.3 yr vs. 67.1 yr; p<0.001) and their cancers less often detected by surveillance, their survival was similar to other etiologies. This was attributed to significantly higher incidental presentation (38.2%) and lower prevalence of cirrhosis (77.2%).

Conclusions: HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most of the cases is poor, but older patients with co-morbidities can do well, managed, within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.

Keywords: AIH; ALD; BCLC; BSC; Barcelona Clinic for Liver Cancer; CLD; HBV; HCC; HCV; HPB; Hepatocellular cancer; MDM; Multidisciplinary team; NAFLD; Non-alcoholic fatty liver disease; OLTx; Obesity; PBC; Type 2 diabetes; alcoholic liver disease; autoimmune hepatitis; best supportive care; chronic liver disease; hepatitis B; hepatitis C; hepatocellular cancer; hepatopancreatobiliary; multidisciplinary meeting; non-alcoholic fatty liver disease; orthotopic liver transplant; primary biliary cirrhosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Diabetes Mellitus, Type 2 / complications*
  • Fatty Liver / complications
  • Humans
  • Liver Neoplasms / mortality*
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease
  • Obesity / complications*
  • Risk Factors