{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:09:44Z","timestamp":1760231384869,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Monash University Summer Scholarship Award"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Non-alcoholic fatty liver disease (NAFLD) has become the most prevalent liver disease in Australia and is recognised to play a role in the development of hepatocellular carcinoma (HCC). There are no clear guidelines regarding screening for HCC in NAFLD. The aim of this retrospective study was to compare the characteristics and survival rates of NAFLD-HCC to patients with non-NAFLD-HCC to help guide future research in this area. Methods: A total of 152 HCC patients with either NAFLD (n = 36) or non-NAFLD (n = 116) were retrospectively analysed from the HCC database and medical records. Chi-square and independent t-test were used to compare baseline characteristics and Kaplan\u2013Meier curves and Cox models were used for survival analysis. Results: Patients with NAFLD-HCC were more likely to be diagnosed due to symptoms rather than through screening, and at an older age, compared with non-NAFLD HCC. The median survival rates were lower in NAFLD-HCC (17.2 months) than in those with non-NAFLD-HCC (23.5 months). Conclusion: There is a rise in the number of HCC cases in patients with NAFLD, and this has significant implications for hepatologists as they are presented with more advanced diseases and have poorer outcomes. Future studies on HCC will need to identify this group earlier in order to have an impact on the HCC survival rate.<\/jats:p>","DOI":"10.3390\/nu14183875","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T04:28:55Z","timestamp":1663648135000},"page":"3875","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Is Hepatocellular Carcinoma in Fatty Liver Different to Non-Fatty Liver?"],"prefix":"10.3390","volume":"14","author":[{"given":"Xuan-vinh Kevin","family":"Nguyen","sequence":"first","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne 3128, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Zhang","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne 3128, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken Lee","family":"Chin","sequence":"additional","affiliation":[{"name":"Central Clinical School, Monash University, Melbourne 3004, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Bloom","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University, Melbourne 3128, Australia"},{"name":"Eastern Health, Department of Gastroenterology, 8 Arnold Street, Box Hill, Melbourne 3128, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-2757","authenticated-orcid":false,"given":"Amanda J.","family":"Nicoll","sequence":"additional","affiliation":[{"name":"Eastern Health, Department of Gastroenterology, 8 Arnold Street, Box Hill, Melbourne 3128, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1053\/j.gastro.2007.04.061","article-title":"Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis","volume":"132","author":"Rudolph","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/S0140-6736(16)30579-7","article-title":"The global burden of viral hepatitis from 1990 to 2013: Findings from the Global Burden of Disease Study 2013","volume":"388","author":"Stanaway","year":"2016","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1111\/j.1440-1746.2007.05293.x","article-title":"Alcohol, cofactors and the genetics of hepatocellular carcinoma","volume":"23","author":"Yu","year":"2008","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_5","unstructured":"Deloitte Access Economics (2013). The economic cost and health burden of liver diseases in Australia. Gastroenterological Society of Australia, Australian Liver Association."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0168-8278(01)00151-9","article-title":"The spectrum of liver disease in the general population: Lesson from the Dionysos study","volume":"35","author":"Bellentani","year":"2001","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1002\/hep.23527","article-title":"The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis","volume":"51","author":"Ascha","year":"2010","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jgh.14270","article-title":"Burden of non-alcoholic fatty liver disease in Australia","volume":"33","author":"Mahady","year":"2018","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1002\/hep.25536","article-title":"Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease","volume":"55","author":"Reddy","year":"2012","journal-title":"Hepatology"},{"key":"ref_10","first-page":"124","article-title":"Hepatocellular Carcinoma in the Absence of Cirrhosis in United States Veterans is Associated With Nonalcoholic Fatty Liver Disease","volume":"14","author":"Mittal","year":"2016","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/hep.24199","article-title":"Management of hepatocellular carcinoma: An update","volume":"53","author":"Bruix","year":"2011","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1055\/s-0030-1247132","article-title":"Modified RECIST (mRECIST) assessment for hepatocellular carcinoma","volume":"30","author":"Lencioni","year":"2010","journal-title":"Semin. Liver Dis."},{"key":"ref_15","unstructured":"National Health and Medical Research Council (2017, November 24). NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol, Available online: http:\/\/www.nhmrc.gov.au\/_files_nhmrc\/publications\/attachments\/ds10-alcohol.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4254\/wjh.v11.i1.1","article-title":"Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review","volume":"11","author":"Desai","year":"2019","journal-title":"World J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4251\/wjgo.v5.i9.186","article-title":"Primary hepatocellular carcinoma and metabolic syndrome: An update","volume":"5","author":"Rahman","year":"2013","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/2251-6581-13-57","article-title":"Insight into the impact of diabetes mellitus on the increased risk of hepatocellular carcinoma: Mini-review","volume":"13","author":"Ahmad","year":"2014","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1136\/gutjnl-2011-301708","article-title":"Metformin decreases hepatocellular carcinoma risk in a dose-dependent manner: Population-based and in vitro studies","volume":"62","author":"Chen","year":"2013","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1038\/nrc2945","article-title":"The renin\u2013angiotensin system and cancer: Old dog, new tricks","volume":"10","author":"George","year":"2010","journal-title":"Nat. Rev. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"322","DOI":"10.6004\/jnccn.2018.7105","article-title":"Comparative Analysis of Nonalcoholic Steatohepatitis- Versus Viral Hepatitis- and Alcohol-Related Liver Disease-Related Hepatocellular Carcinoma","volume":"17","author":"Hester","year":"2019","journal-title":"J. Natl. Compr. Cancer Netw. JNCCN"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1245\/s10434-013-3211-3","article-title":"Recurrence patterns and prognostic factors in patients with hepatocellular carcinoma in noncirrhotic liver: A multi-institutional analysis","volume":"21","author":"Arnaoutakis","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","first-page":"73","article-title":"Comparing clinical presentations, treatments and outcomes of hepatocellular carcinoma due to hepatitis C and non-alcoholic fatty liver disease","volume":"110","author":"Than","year":"2017","journal-title":"QJM Mon. J. Assoc. Physicians"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1002\/hep.22734","article-title":"Hepatocellular carcinomas in patients with metabolic syndrome often develop without significant liver fibrosis: A pathological analysis","volume":"49","author":"Paradis","year":"2009","journal-title":"Hepatology (Baltimore, Md)"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1002\/hep.27014","article-title":"Opposite association between diabetes, dyslipidemia, and hepatocellular carcinoma mortality in the middle-aged and elderly","volume":"59","author":"Chiang","year":"2014","journal-title":"Hepatology"},{"key":"ref_26","first-page":"935","article-title":"Association Between PNPLA3 rs738409 C>G Variant and Liver-Related Outcomes in Patients with Non-alcoholic Fatty Liver Disease","volume":"18","author":"Grimaudo","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s00535-017-1414-2","article-title":"Clinical strategy of diagnosing and following patients with nonalcoholic fatty liver disease based on invasive and noninvasive methods","volume":"53","author":"Yoneda","year":"2018","journal-title":"J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"(2012). EASL-EORTC clinical practice guidelines: Management of hepatocellular carcinoma. J. Hepatol., 56, 908\u2013943.","DOI":"10.1016\/j.jhep.2011.12.001"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/13651820410024067","article-title":"Surgical treatment of hepatocellular carcinoma","volume":"7","author":"Belghiti","year":"2005","journal-title":"HPB"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/dmrr.1291","article-title":"Diabetes mellitus and risk of hepatocellular carcinoma: A systematic review and meta-analysis","volume":"28","author":"Wang","year":"2012","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1872-034X.2011.00915.x","article-title":"Difference in malignancies of chronic liver disease due to non-alcoholic fatty liver disease or hepatitis C in Japanese elderly patients","volume":"42","author":"Arase","year":"2012","journal-title":"Hepatol. Res. Off. J. Jpn. Soc. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.3748\/wjg.v21.i4.1189","article-title":"Characteristics of hepatocellular carcinoma in cirrhotic and non-cirrhotic non-alcoholic fatty liver disease","volume":"21","author":"Leung","year":"2015","journal-title":"World J. Gastroenterol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/18\/3875\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:34:20Z","timestamp":1760142860000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/18\/3875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,19]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["nu14183875"],"URL":"https:\/\/doi.org\/10.3390\/nu14183875","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2022,9,19]]}}}