Many Patients With NAFLD Should Be Screened for Liver Cancer, Experts Say

By Reuters Staff

February 11, 2020

NEW YORK (Reuters Health) - Screening and surveillance for hepatocellular carcinoma (HCC) is important in many patients with nonalcoholic fatty liver disease (NAFLD), according to an expert panel of the American Gastroenterological Association (AGA).

"The incidence of NAFLD-related HCC is increasing in the United States," Dr. Rohit Loomba, director of the NAFLD Research Center at the University of California, San Diego, in La Jolla, and colleagues note in Gastroenterology.

"Despite this rise in the incidence, screening and surveillance for HCC among patients at risk of developing HCC is suboptimal in general, and is disproportionately lower in patients with NAFLD-related HCC. Therefore, there is a major unmet need to provide clear best practice advice to clinicians regarding risk assessment of HCC among patients with NAFLD and appropriate screening and surveillance strategies," they write.

Following an evidenced-based review addressing HCC risk in patients with NAFLD, the panel developed the following "Best Practice Advice" statements to guide clinical management:

1: Screening for HCC should be considered in all patients with cirrhosis due to NAFLD.

2: Patients with NAFLD with non-invasive markers showing evidence of advanced liver fibrosis or cirrhosis should be considered for HCC screening.

3: Patients with NAFLD in the absence of advanced liver fibrosis should not be routinely considered for HCC screening.

4: Adequacy of ultrasound in assessing the liver parenchyma for mass lesions should be documented when used for HCC screening in patients with cirrhosis due to NAFLD.

5: When the quality of ultrasonography is sub-optimal for screening of HCC (e.g., due to obesity) future screening should be performed by either CT or MRI scan, with or without AFP, every six months.

6: Patients with cirrhosis due to NAFLD should be counseled on abstaining from alcohol and tobacco.

7: Optimal management of diabetes and dyslipidemia through lifestyle modification and pharmacotherapy is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for HCC.

8: Optimal management of obesity through lifestyle modification, pharmacotherapy or endoscopic or surgical bariatric procedures is encouraged in patients with NAFLD and advanced liver fibrosis who are at risk for HCC.

Dr. Loomba serves on the steering committee of the REGENERATE Trial funded by Intercept Pharmaceuticals, is a co-founder of Liponexus Inc and serves as a consultant or advisory board member for several pharmaceutical companies.

Dr. Loomba did not respond to a request for comment by press time.

SOURCE: Gastroenterology, online January 29, 2020.