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Predictors of malignancies and overall mortality in J apanese patients with biopsy‐proven non‐alcoholic fatty liver disease
Author(s) -
Seko Yuya,
Sumida Yoshio,
Tanaka Saiyu,
Taketani Hiroyoshi,
Kanemasa Kazuyuki,
Ishiba Hiroshi,
Okajima Akira,
Nishimura Takeshi,
Yamaguchi Kanji,
Moriguchi Michihisa,
Mitsuyoshi Hironori,
Yasui Kohichiroh,
Minami Masahito,
Itoh Yoshito
Publication year - 2015
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12407
Subject(s) - medicine , gastroenterology , fatty liver , hepatocellular carcinoma , hazard ratio , steatohepatitis , cancer , incidence (geometry) , malignancy , proportional hazards model , liver biopsy , liver cancer , disease , confidence interval , biopsy , physics , optics
Aim Some patients with non‐alcoholic fatty liver disease ( NAFLD ) develop hepatocellular carcinoma ( HCC ) and have higher mortality than others. The evidence causally linking NAFLD to extrahepatic malignancies is scarce. Our aim was to determine the incidence of and risk factors for HCC , extrahepatic cancer and mortality in Japanese patients with biopsy‐proven NAFLD . Methods This retrospective cohort study analyzed outcomes including onset of malignant tumors and death in 312 patients with NAFLD diagnosed by liver biopsy. Results Of 312 patients, 176 (56.4%) were diagnosed with non‐alcoholic steatohepatitis. During a median follow‐up period of 4.8 years (range, 0.3–15.8), six patients (1.9%) developed HCC , and 20 (6.4%) developed extrahepatic cancer. Multivariate analysis identified fibrosis stage (≥3; hazard ratio [ HR ], 12.3; 95% confidence interval [ CI ], 1.11–136.0; P = 0.041) as a predictor for HCC and type IV collagen 7s (>5 ng/mL; HR , 1.74; 95% CI , 1.08–2.79; P = 0.022) as a predictor for extrahepatic cancer. Eight patients (2.6%) died during the follow‐up period. The most common cause of death was extrahepatic malignancy. None died of cardiovascular disease. Multivariate analysis identified type IV collagen 7s (>5 ng/mL; HR , 3.38; 95% CI , 1.17–9.76; P = 0.024) as a predictor for mortality. Conclusion The incidence of extrahepatic cancer was higher than that of HCC . Severe fibrosis was a predictor for HCC . Patients with NAFLD and elevated type IV collagen 7s levels are at increased risk for extrahepatic cancer and overall mortality.