TY - JOUR
T1 - Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002-2033: the ITA.LI.CA database
AU - Vitale, Alessandro
AU - Svegliati-Baroni, Gianluca
AU - Ortolani, Alessio
AU - Cucco, Monica
AU - Riva, Giulio V Dalla
AU - Giannini, Edoardo G
AU - Piscaglia, Fabio
AU - Rapaccini, Gianludovico
AU - Di Marco, Mariella
AU - Caturelli, Eugenio
AU - Zoli, Marco
AU - Sacco, Rodolfo
AU - Cabibbo, Giuseppe
AU - Marra, Fabio
AU - Mega, Andrea
AU - Morisco, Filomena
AU - Gasbarrini, Antonio
AU - Foschi, Francesco Giuseppe
AU - Missale, Gabriele
AU - Masotto, Alberto
AU - Nardone, Gerardo
AU - Raimondo, Giovanni
AU - Azzaroli, Francesco
AU - Vidili, Gianpaolo
AU - Oliveri, Filippo
AU - Pelizzaro, Filippo
AU - Morales, Rafael Ramirez
AU - Cillo, Umberto
AU - Trevisani, Franco
AU - Miele, Luca
AU - Marchesini, Giulio
AU - Farinati, Fabio
PY - 2021
Y1 - 2021
N2 - Background Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort. Methods We analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC. Results MAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002-2003, to 77.3% and 28.9% in 2018-2019, respectively, p<0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumours and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p=0.026, p=0.004) and HCC-related (p<0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p=0.006). Conclusions The prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.
AB - Background Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort. Methods We analysed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centres to compare epidemiological and future trends in three subgroups: pure, single aetiology MAFLD (S-MAFLD); mixed aetiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC. Results MAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002-2003, to 77.3% and 28.9% in 2018-2019, respectively, p<0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumours and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p=0.026, p=0.004) and HCC-related (p<0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p=0.006). Conclusions The prevalence of MAFLD HCC in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favourable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.
KW - hepatocellular carcinoma
KW - nonalcoholic steatohepatitis
KW - hepatocellular carcinoma
KW - nonalcoholic steatohepatitis
UR - http://hdl.handle.net/10807/219693
U2 - 10.1136/gutjnl-2021-324915
DO - 10.1136/gutjnl-2021-324915
M3 - Article
SN - 1468-3288
VL - 2021
SP - N/A-N/A
JO - EGUT
JF - EGUT
ER -