Characteristics Of Hepatocellular Carcinoma Associated With Nonalcoholic Fatty Liver Disease:A Meta Analysis

Objective: hepatocellular carcinoma is one of the most common malignant tumors in the world,which is the most malignant one.The global morbidity rank 6th and mortality 4th.In China,the incidence rate and the mortality rate is the third respectively.Among the causes of hepatocellular carcinoma,in addition to known HBV and HCV,the discussion on the causes of hepatocellular carcinoma caused by non-alcoholic fatty liver disease has been increasing gradually at present,but the characteristics of hepatocellular carcinoma associated with non-alcoholic fatty liver disease are rarely reported.In order to further explore the relationship between the two and the specific characteristics of hepatocellular carcinoma associated with non-alcoholic fatty liver disease,a Meta-analysis was conducted on published studies.Methods: Computer retrieval CNKI,matt strong,wanfang,Pubmed,EMBASE,the Cochrane Library to build Library in December 2019,nonalcoholic fatty liver disease associated with hepatocellular carcinoma research and analysis,manual retrieve relevant information at the same time,in strict accordance with the filtered into and exclusion criteria,extract data and quality evaluation,after the completion of the application software stata16.0 Meta analysis.Results: A total of 29 literatures were included,including 2 literatures in Chinese and 27 literatures in English.Among them,there were 13 retrospective studies,and a total of 39,280 patients with hepatocellular carcinoma were analyzed,including 4318 patients with non-alcoholic fatty liver disease associated hepatocellular carcinoma.A single-group rate Meta-analysis of HCC patients due to NAFLD was conducted in retrospective studies,and the results showed that the proportion of NAFLD-HCC in HCC patients was 11%(95%CI=0.08-0.13).A total of 8225 patients with NAFLD were followed up in 6 prospective studies,including 199 patients with HCC.Further single-group rate Meta-analysis showed that the incidence of HCC in NAFLD population was 8%(95%CI=0.02-0.13).In addition,this study focused on the analysis of the clinical characteristics of NAFLD-HCC patients.We performed a Meta-analysis on the clinical characteristics of NAFLD-HCC and non-NAFLD-HCC patients,such as gender,number of tumors,combined with type 2 diabetes,and whether patients with cirrhosis were involved.In terms of gender,the proportion of men with NAFLD associated HCC was lower than those with other causes(OR=0.64,P=0.000,95%CI=0.51-0.80).In terms of the number of tumors,patients with non-alcoholic fatty liver disease associated HCC had a higher percentage of single tumors compared with those caused by other causes(OR=1.33,95%CI=1.05-1.69).In terms of type 2 diabetes,patients with non-alcoholic fatty liver disease associated HCC had a higher incidence of type 2 diabetes(OR=5.14,95%CI=3.54-7.41).On this basis,we studied the proportion of patients with or without cirrhosis in NAFLD related HCC.We performed a single-group rate Meta-analysis on patients without cirrhosis in NAFLD related HCC,and the results showed that the proportion of patients without cirrhosis in NAFLD patients was 41%(95%CI=0.34-0.48).For further exploration of nonalcoholic fatty liver disease associated with and without cirrhosis of the hepatocellular carcinoma characteristics difference,we respectively in the presence OR absence of cirrhosis of the liver of patients with nonalcoholic fatty liver disease related liver cancer in sex,tumor size,tumor number,whether Meta analysis combined with type 2diabetes,liver cirrhosis group and no cirrhosis group sex ratio has no obvious difference(OR = 0.43,P = 0.005,95% CI = 0.19 1.01).In the comparison study of tumor size between NAFLD-HCC patients with cirrhosis and non-cirrhosis,OR=0.16,P=0.04,95%CI=0.03-0.89),the results showed that the tumor size of NAFLD-HCC patients without cirrhosis was relatively large.In terms of the number of tumors,patients without cirrhosis had more single tumors in NAFLD-HCC than patients with cirrhosis(OR=0.55,P=0.000,95%CI=0.37,.83).The incidence of NAFLD-HCC with type 2diabetes after cirrhosis was relatively high(OR=2.24,P=0.188,95%CI=1.50,3.36).Conclusion:1.Non-alcoholic fatty liver disease is one of the risk factors of hepatocellular carcinoma.2.Compared with hepatocellular carcinoma caused by other causes,the proportion of male patients with hepatocellular carcinoma related to non-alcoholic fatty liver disease is lower,the tumor is relatively single,and more likely to be complicated with type 2 diabetes.3.Non-alcoholic fatty liver disease can develop into hepatocellular carcinoma without the stage of cirrhosis.Patients with non-alcoholic fatty liver disease are more likely to develop liver cancer without progressing through the cirrhosis stage than those with other causes.4.Compared with NAFLD-HCC patients with cirrhosis,the tumors in NAFLD-HCC patients without cirrhosis stage were larger and relatively solitary.NAFLD-HCC patients with cirrhosis are more likely to have type 2diabetes.