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

Lookup NU author(s): Dr Jess Dyson, Dr Dipanker Chattopadhyay, Rajiv Lochan Jayadeva, Dr Imran Patanwala, Mike Cole, Dr Kate Sumpter, Dr Stephen Stewart, Dr John Rose, Professor Derek Manas, Professor Helen Reeves

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Abstract

BACKGROUND: 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 (71.3yrs versus 67.1yrs; 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%). CONCLUSION: HCC related mortality is increasing, with typical patients being elderly with metabolic risk factors. The prognosis for most is poor, but older patients with co-morbidities can do well managed within a specialist multidisciplinary team if their cancer is detected pre-symptomatically.


Publication metadata

Author(s): Dyson J, Jaques B, Chattopadyhay D, Lochan R, Graham J, Das D, Aslam T, Patanwala I, Gaggar S, Cole M, Sumpter K, Stewart S, Rose J, Hudson M, Manas D, Reeves HL

Publication type: Article

Publication status: Published

Journal: Journal of Hepatology

Year: 2014

Volume: 60

Issue: 1

Pages: 110-117

Print publication date: 01/01/2014

Online publication date: 23/08/2013

Acceptance date: 12/08/2013

ISSN (print): 0168-8278

ISSN (electronic): 1600-0641

Publisher: Elsevier BV

URL: http://dx.doi.org/10.1016/j.jhep.2013.08.011

DOI: 10.1016/j.jhep.2013.08.011


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