Statin Therapy for Prophylaxis of HCC in NASH with Cirrhosis

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To estimate the annual incidence of hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) with advanced liver fibrosis, and to determine the risk factors for development of HCC and the chemoprotective effect of statin use stratified by fibrosis stage, a retrospective study was carried out at two U.S. tertiary academic centers, including patients with NASH-related advanced liver fibrosis (bridging fibrosis – F3 and cirrhosis – F4), followed between July 2002 and June 2016. Patients were followed from the day of diagnosis to the day of last abdominal imaging, liver transplantation or HCC diagnosis. Multivariable Cox regression analysis was performed to evaluate the risk factors associated with HCC development, stratified by fibrosis stage.
A total of 1072 patients were included; 122 patients with F3 fibrosis and 950 patients with cirrhosis. No HCC was observed during 602 person-year follow up among F3 patients. Among patients with cirrhosis, HCC developed in 82 patients with an annual incidence rate of 1.90 per 100 person-years. Multivariable analysis in patients with cirrhosis demonstrated that HCC development was associated with male sex (HR 4.06), older age (HR 1.05), and CTP score (HR 1.38). Statin use was associated with a lower risk of developing HCC (HR 0.40). Each 365 increment in cumulative defined daily dose of statin use reduced the HCC risk by 23.6%.
The findings suggested that patients with NASH and bridging fibrosis have a low risk of HCC. Dose-dependent statin use reduced HCC risk significantly in patients with NASH cirrhosis.

Pinyopornpanish, K., Al-Yaman, W., Butler, R., et al. “Chemopreventive Effect of Statin on Hepatocellular Carcinoma in Patients with Nonalcoholic Steatohepatitis Cirrhosis.” American Journal of Gastroenterology, Vol. 116, November 2021, pp. 2258-2269.

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