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<h5 class="section-title" id="d263334e256">Background</h5>
<p id="P2">There are limited data on the risk of hepatocellular cancer (HCC) in patients
with
non-alcoholic fatty liver disease (NAFLD). We aimed to estimate the risk of incident
HCC among patients with NAFLD.
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<h5 class="section-title" id="d263334e261">Methods</h5>
<p id="P3">We conducted a retrospective cohort study from a total of 130 facilities
in the Veterans
Health Administration. Patients with NAFLD diagnosed between 1/1/2004 and 12/31/2008
were included and followed until HCC diagnosis, death or 12/31/2015. We also identified
a gender and age-matched control cohort without NAFLD. We ascertained all new HCC
cases from the Central Cancer Registry and manual chart reviews. We calculated incidence
rates for HCC by NAFLD status as well as in subgroups of NAFLD patients. We used competing
risk models to compare the risk of HCC in patients with
<i>vs</i>. those without NAFLD. We reviewed electronic medical records of all HCC
cases that
developed in NAFLD patients without cirrhosis.
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<h5 class="section-title" id="d263334e269">Results</h5>
<p id="P4">We compared 296,707 NAFLD patients with 296,707 matched controls. During
2,382,289
person-years [PY] of follow-up, 490 NAFLD patients developed HCC (0.21/1000 PY). HCC
incidence was significantly higher among NAFLD patients
<i>vs.</i> controls (0.02/1000 PY; hazard ratio, 7.62, 95% confidence interval=5.76–10.09).
Among patients with NAFLD, those with cirrhosis had the highest annual incidence of
HCC (10.6 /1000 PY). Among patients with NAFLD cirrhosis, HCC risk ranged from 1.6
to 23.7 per 1000 PY based on other demographic characteristics; the risk of HCC was
the highest in older Hispanics with cirrhosis. In medical record reviews, 20% of NAFLD
patients with HCC had no evidence of cirrhosis.
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<h5 class="section-title" id="d263334e277">Conclusions</h5>
<p id="P5">Risk of HCC was higher in NAFLD patients than that observed in general
clinical population.
Most HCC cases in NAFLD developed in patients with cirrhosis. The absolute risk of
HCC was higher than the accepted thresholds for HCC surveillance for most patients
with NAFLD cirrhosis.
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