[1719] The Steatohepatitic Variant of Hepatocellular Carcinoma Is Associated with Non-Alcoholic Steatohepatitis

Jacob Forrest Busler, Sunil K Geevarghese, Burnett S Kelly, Mary Kay Washington. Vanderbilt University Medical Center, Nashville, TN

Background: While individual features of non-alcoholic steatohepatitis (NASH) such as fat, inflammation, fibrosis, and ballooning degeneration with or without Mallory's hyaline, are relatively common in hepatocellular carcinoma (HCC), the combination of these features to produce changes resembling NASH within the tumor is relatively rare. This steatohepatitic variant of HCC (SH-HCC) has been described in association with chronic hepatitis C (HCV). We hypothesized that SH-HCC may also arise in the setting of NASH.
Design: We reviewed all available resection and transplant cases of HCC from the surgical pathology files of our institution from 1994-2011. Tumors were evaluated for features of NASH: steatosis, ballooning degeneration, inflammation, pericellular fibrosis, and Mallory's hyaline. Cases were classified as SH-HCC if 4 or 5 of these features were present. Clinical records were reviewed for patient age, gender, body mass index (BMI), alcohol abuse history, and etiology of underlying liver disease. Frequency distributions were evaluated by a χ² test.
Results: A total of 238 tumors from 236 patients were examined, including 156 explants and 80 partial hepatic resections. 114 tumors showed no features of NASH, and 55 showed 1 to 3 features. Sixty-nine (29.2%) showed 4 or 5 and were classified as SH-HCC. Clinical characteristics by HCC subtype are shown in Table 1.

Clinical Features in SH-HCC versus Standard HCC

	SH-HCC (n=69)	Standard HCC (n=169)
Age (mean, y)	59.0	57.0
Gender (M/F)	62/5	135/34
BMI (mean)	28.3	28.9
Alcohol abuse	13 (18.8%)	37 (22.0%)	NS
HCV	37 (53.6%)	99 (58.6%)	NS
NASH or cryptogenic	14 (20.3%)	15 (8.8%)	p=0.015

NS=Not statistically significant

Patient age, BMI, alcohol history, and HCV status were similar between SH-HCC and standard HCC. Fewer SH-HCC patients were women (7.3%) than standard HCC patients were (20.1%). Among SH-HCC patients, 14 (20.3%) had either cirrhosis secondary to NASH or cryptogenic cirrhosis, compared to 15 (8.8%) among patients with standard HCC (p=0.015).
Conclusions: The SH-HCC pattern is associated with underlying NASH in our population. Patients with HCV-related HCC appear no more likely to have SH-HCC than the general population of HCC patients does. These data suggest an etiologic link between NASH and a steatohepatitic phenotype in HCC that is different from the HCC variant in HCV patients. This correlation could impact treatment options and outcomes for this growing population of patients.
Category: Liver

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 246, Tuesday Morning