By Kristina Fiore, Staff Writer, MedPage Today Published: October 22, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
SAN ANTONIO -- Even in the absence of cirrhosis and fatty liver, obese patients may still be at increased risk for liver cancer, researchers said here.
Patients with noncirrhotic hepatocellular carcinoma had a higher body mass index (BMI) as well as a higher prevalence of diabetes than those in the general population, Benjamin Mitlyng, MD, of the University of Minnesota in Minneapolis, and colleagues reported at the American College of Gastroenterology meeting.
"This supports previous data that there may be an association with noncirrhotic hepatocellular carcinoma and an elevated BMI as well as diabetes, independent of steatosis," they wrote.
While still rare, it has been estimated that up to 10% of liver cancers occur in patients who don't have cirrhosis.
Insulin resistance and obesity have both been suggested as risk factors for noncirrhotic hepatocellular carcinoma.
To assess those relationships, the researchers looked at data from a cohort of 12 patients with noncirrhotic hepatocellular carcinoma who had a partial hepatectomy between January 2008 and September 2009 at a single center.
Their average age was 60, with an average BMI of 27.6.
A third of the patients had diabetes -- a much higher prevalence than that of the general population, the researchers said (33% versus 6%).
A higher proportion was overweight or obese compared with the general population as well (67% versus 60%).
All patients had preoperative testing for underlying liver disease that was negative in all but two patients, both of whom had hemochromatosis.
Only two patients had mild steatosis, the researchers said.
Vascular invasion was observed in five of the 12 lesions with six well-differentiated and six moderately-differentiated carcinomas. None were fibrolamellar.
The researchers said there were no recurrences during an average follow-up of 17.5 months.
They concluded that patients with noncirrhotic liver cancer had a high prevalence of diabetes and elevated BMI, despite a lack of steatosis.
David Johnson, MD, of Eastern Virginia Medical School in Norfolk, Va., who wasn't involved in the study, said the findings highlight the fact that some mechanism related to obesity or overweight is at work, perhaps one involved in the inflammatory response, which is elevated in this group.
"They don't have to have end-stage liver disease, but fat in the liver may be handled in the wrong way, so that it metabolically changes the liver dynamic to create an incremental cancer risk before patients get to that stage of cirrhosis," he said.
Johnson added that fatty tissue is metabolically active -- "that inflammation may generate a substance that creates havoc with every body system, particularly in the pathways that can result in precancerous growth."
Walter Coyle, MD, of Scripps Clinic in La Jolla, Calif., who was not involved in the study either, added that it would also be interesting to examine the role of gut microbiota in the development of liver cancer in this population.
The researchers reported no conflicts of interest.
Primary source: American College of Gastroenterology
Source reference:
Mitlyng B, et al "Hepatocellular carcinoma in the non-cirrhotic liver is associated with a high body mass index independent of steatosis" ACG 2010; Abstract 290.
Source
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