Comparing clinical presentations, treatments and outcomes in hepatocellular carcinoma due to Hepatitis C and Non Alcoholic Fatty Liver Disease

Research output: Contribution to journalArticlepeer-review


  • Anwar Ghazanfar
  • James Hodson
  • Nadeem Tehami
  • Chris Coldham
  • Hynek Mergental
  • Derek Manas
  • Tahir Shah
  • Helen Reeves

Colleges, School and Institutes

External organisations

  • Newcastle Upon Tyne Hosp NHS Trust
  • The Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
  • Newcastle Upon Tyne Hosp
  • University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK


INTRODUCTION: Hepatocellular carcinoma (HCC) is increasing in incidence in the UK and globally. Liver cirrhosis is the common cause for developing HCC. The common reasons for liver cirrhosis are viral hepatitis C (HCV), viral hepatitis B and alcohol. However, HCC caused by non-alcoholic fatty liver disease (NAFLD)-cirrhosis is now increasingly as a result of rising worldwide obesity.

AIM: To compare the clinical presentation, treatment options and outcomes of hepatocellular carcinoma due to HCV and NAFLD patients.

METHODS: Data were collected from two liver transplant centres in the United Kingdom (Birmingham and Newcastle upon Tyne) between 2000 and 2014. We compared 275 patients with HCV-related HCC against 212 patients with NAFLD- related HCC.

RESULTS: Patients in the NAFLD group were found to be significantly older (p<0.001) and more likely to be Caucasian (p<0.001). They had lower rates of cirrhosis (p<0.001) than those in HCV-HCC group. The NAFLD group presented with significantly larger tumours (p=0.009), whilst HCV patients had a higher alpha fetoprotein (AFP) (p=0.018). NAFLD patients were more commonly treated with TACE (p=0.005) than the HCV patients, whilst the HCV group were significantly more likely to be transplanted (p<0.001). In patients selected for liver transplantation, 5-year survival rates in NAFLD were not significantly different from HCV-HCC (44% and 56% respectively, p=0.102).

CONCLUSION: In this study NAFLD patients presented with larger tumours that were less likely to be amenable to curative therapy, as compared with HCV patients. Despite this disadvantage, patients with NAFLD had similar overall survival compared to patients with HCV.

Bibliographic note

Manuscript ID: QJM-2016-009.R1


Original languageEnglish
Pages (from-to)73-81
JournalQJM: An International Journal of Medicine
Issue number2
Early online date10 Sep 2016
Publication statusPublished - Feb 2017


  • hepatocellular carcinoma, Hepatitis C, Non-alcoholic fatty liver disease, survival, liver transplantation