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Incidence of Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-analysis, and Meta-regression. Clin Gastroenterol Hepatol 2022; 20:283-292.e10. [PMID: 33965578 DOI: 10.1016/j.cgh.2021.05.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis. METHODS In this systematic review, we searched Web of Science, Embase, PubMed, and the Cochrane Library from January 1, 1950 through July 30, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. RESULTS We included 18 studies involving 470,404 patients. In patients with NAFLD at a stage earlier than cirrhosis, the incidence rate of HCC was 0.03 per 100 person-years (95% confidence interval [CI], 0.01-0.07; I2 = 98%). In patients with cirrhosis, the incidence rate was 3.78 per 100 person-years (95% CI, 2.47-5.78; I2 = 93%). Patients with cirrhosis undergoing regular screening for HCC had an incidence rate of 4.62 per 100 person-years (95% CI, 2.77-7.72; I2 = 77%). CONCLUSIONS Patients with NAFLD-related cirrhosis have a risk of developing HCC similar to that reported for patients with cirrhosis from other etiologies. Evidence documenting the risk in patients with nonalcoholic steatohepatitis or simple steatosis is limited, but the incidence of HCC in these populations may lie below thresholds used to recommend a screening. Well-designed prospective studies in these subpopulations are needed. The protocol for this systematic review is registered in the Prospero database (registration number CRD42018092861).
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Bayik D, Lauko AJ, Roversi GA, Serbinowski E, Acevedo-Moreno LA, Lanigan C, Orujov M, Lo A, Alban TJ, Kim A, Silver DJ, Nagy LE, Brown JM, Allende DS, Aucejo FN, Lathia JD. Hepatobiliary malignancies have distinct peripheral myeloid-derived suppressor cell signatures and tumor myeloid cell profiles. Sci Rep 2020; 10:18848. [PMID: 33139767 PMCID: PMC7606602 DOI: 10.1038/s41598-020-75881-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) are immunosuppressive cells that are increased in patients with numerous malignancies including viral-derived hepatocellular carcinoma (HCC). Here, we report an elevation of MDSCs in the peripheral blood of patients with other hepatobiliary malignancies including non-viral HCC, neuroendocrine tumors (NET), and colorectal carcinoma with liver metastases (CRLM), but not cholangiocarcinoma (CCA). The investigation of myeloid cell infiltration in HCC, NET and intrahepatic CCA tumors further established that the frequency of antigen-presenting cells was limited compared to benign lesions, suggesting that primary and metastatic hepatobiliary cancers have distinct peripheral and tumoral myeloid signatures. Bioinformatics analysis of The Cancer Genome Atlas dataset demonstrated that a high MDSC score in HCC patients is associated with poor disease outcome. Given our observation that MDSCs are increased in non-CCA malignant liver cancers, these cells may represent suitable targets for effective immunotherapy approaches.
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Affiliation(s)
- Defne Bayik
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
- Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
| | - Adam J Lauko
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Gustavo A Roversi
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
| | - Emily Serbinowski
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
| | | | | | - Mushfig Orujov
- Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Pathological Anatomy, Azerbaijan Medical University, 1022, Baku, Azerbaijan
| | - Alice Lo
- Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Tyler J Alban
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
| | - Adam Kim
- Department of Inflammation and Immunity, Northern Ohio Alcohol Center, Center for Liver Disease Research, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Daniel J Silver
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
| | - Laura E Nagy
- Department of Inflammation and Immunity, Northern Ohio Alcohol Center, Center for Liver Disease Research, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, 44195, USA
| | - J Mark Brown
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA
- Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA
- Liver Cancer Center of Excellence, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Daniela S Allende
- Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA
- Liver Cancer Center of Excellence, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Federico N Aucejo
- Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Liver Cancer Center of Excellence, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Justin D Lathia
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE3-202, Cleveland, OH, 44195, USA.
- Case Comprehensive Cancer Center, Cleveland, OH, 44106, USA.
- Liver Cancer Center of Excellence, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Noda Y, Kawaguchi T, Kuromatsu R, Komukai S, Nakano M, Niizeki T, Koga H, Kawaguchi A, Torimura T. Prognostic profile of patients with non-viral hepatocellular carcinoma: A comparative study with hepatitis C virus-related hepatocellular carcinoma using data mining analysis. Oncol Lett 2019; 18:227-236. [PMID: 31289492 DOI: 10.3892/ol.2019.10285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/04/2019] [Indexed: 12/12/2022] Open
Abstract
Various factors are associated with the prognosis of patients with non-viral hepatocellular carcinoma (HCC). The present study aimed to investigate the prognosis of patients with non-viral HCC compared with that of patients with hepatitis C virus-related (HCV)-HCC and the features associated with prognosis of patients with non-viral HCC using data mining analyses. Patients with non-viral HCC (n=182, age 70.4±8.9 years) and HCV-HCC (n=612, age 70±8.4 years) were enrolled and the overall survival was compared between the non-viral HCC and HCV-HCC groups. The present study performed random forest and decision tree analyses to identify features that distinguish prognosis between the non-viral HCC and HCV-HCC groups. The median survival of the non-viral HCC group was significantly shorter than the HCV-HCC group (1,553 vs. 2,304 days, P<0.01). In the multivariate analysis, the non-viral HCC group was an independent risk factor for survival (HR 1.42, 95% CI 1.08-1.87, P=0.013). In the random forest analysis, the high-ranking distinguishable factors were 'number of tumors' and 'HCC stage' in the non-viral HCC group and 'albumin' and 'total bilirubin' in the HCV-HCC group. The decision tree analysis revealed that, in patients with HCC stage >I, the survival period in the non-viral HCC group was significantly shorter than the HCV-HCC group (HR 1.39, 95% CI 1.07-1.81, P=0.0132). The prognosis of patients with non-viral HCC was poorer than patients with HCV-HCC. In addition, data mining analysis revealed that tumor-related variables had the highest importance for survival in patients with non-viral HCC.
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Affiliation(s)
- Yu Noda
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Ryoko Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.,Ultrasound Diagnostic Center, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | - Masahito Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Niizeki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Hironori Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.,Liver Cancer Research Division, Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Atsushi Kawaguchi
- Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga 849-0937, Japan
| | - Takuji Torimura
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan.,Liver Cancer Research Division, Research Center for Innovative Cancer Therapy, Kurume University, Kurume, Fukuoka 830-0011, Japan
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