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Disclosures

Disclosures. Advisory committees. Speaking and teaching. Stocks. Royalties. Agenda. Reason to Assess HCC Risk Parameters Underlying disease Fixed parameters Modifiable parameters Integration. NAFLD and Cancers.

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Disclosures

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  1. Disclosures Advisory committees Speaking and teaching Stocks Royalties

  2. Agenda Reason to Assess HCC Risk Parameters Underlyingdisease Fixedparameters Modifiable parameters Integration

  3. NAFLD and Cancers Retrospective Korean study 25,947 individuals over an average period of 7.5 years Kim et al. J Hepatol 2017

  4. Burden of NAFLD-related HCC Younossi et al. Hepatology 2016

  5. Incidence of HCC in NAFLD Retrospective cohort study from a total of 130 facilities in the Veterans Health Administration. NAFLD: elevated ALT, excluding other known causes HR 7.6 Kanwalet al. Gastroenterology 2018

  6. Reasonstoassess HCC Risk Enroll in a surveillance programpatients with a HCC riskabove a certain threshold (incidence above 1.5%/year for cirrhotics) Do not enroll in a surveillance program patients with a HCC risklowerthanthisthreshold Modify the modifiable risks

  7. Agenda Reason to Assess HCC Risk Parameters Underlyingdisease Fixedparameters Modifiable parameters Integration

  8. HCC and steatosis, fibrosis Multivariate analysis adjusted for age, gender, smoking status, diabetes, hypertension, GGT, HDL cholesterol, LDL cholesterol, and triglycerides. Kim et al. J Hepatol 2017

  9. Activityofthedisease Retrospective analysis of 229 patients with biopsy-proven NAFLD Mean follow-up was 27 years. Reference population: National Registry of Population Hazard Ratios for death due to HCC in histopathological subgroups Ekstedtet al. Hepatology 2015

  10. Activityofthedisease Ekstedtet al. Hepatology 2015

  11. Cirrhosis Yearly cumulative incidence of HCC 2.6% in patients with NASH-cirrhosis 4.0% in patients with HCV cirrhosis Aschaet al. Hepatology 2010

  12. Cirrhosis… not always 4406 HCC cases in one large health-care claims study covering 18 millions lives Sanyalet al. Curr Med ResOpin 2010

  13. Stiffness Each unit increase in LSM was associated with an 11% higher risk of HCC. The results were consistent across Asian and Western populations, all stages of CLD All studies viral hepatitis and TE Singh et al. CGH 2013

  14. Agenda Reason to Assess HCC Risk Parameters Underlyingdisease Fixedparameters Modifiable parameters Integration

  15. Age 352 patients withcirrhosis due to NASH, follow-up 47 months, 30 HCC Factors associated with risk of HCC based on Cox proportional hazards regression Predictorvalidated in the larger UNOS NASH registrant cohort Yang et al. Hepatology 2019

  16. Gender UNOS NASH registrant cohort (N = 6630, 291 HCC) Factors associated with risk of HCC based on Cox proportional hazards regression Yang et al. Hepatology 2019

  17. HCC Incidence in subgroupsofNAFLD patients Kanwalet al. Gastroenterology 2018

  18. Gene: PNPLA3 Singalet al. Am J Gastro 2014

  19. Geneticsof NAFLD-HCC NAFLD-HCC NAFLD cohort UK population Liu et al. J Hepatol 2014

  20. Gene: TM6SF2 Meta-analysis. 28 studies were included for analyses (13,137 cases and 11,010 controls HCC 1433 cases and 2267 controls) Chen et al. MolecularGenetics and GenomicMedicine Commun 2019

  21. Gene: HSD 17B13 Multivariateanalysisafteradjustment for age, sex, and fibrosis Yang et al. Hepatology 2019

  22. Agenda Reason to Assess HCC Risk Parameters Underlyingdisease Fixedparameters Modifiable parameters Integration

  23. Poor dietand Cancer Meta-analysis of prospective cohorts Adults in US Zhang et al. JNCI Cancer Spectrum 2019 Annual cancer cases

  24. Fruit intakeand HCC Meta-analysis of prospective cohort studies Guoet al., Food Funct 2019

  25. Vegetables intakeand HCC Meta-analysis of prospective cohort studies HCC risk was reduced by 4% (P for trend <0.001) with a 100 gr/d increment Guoet al., FooodFunct 2019

  26. Butter and HCC 2 prospective cohortstotalizing 51418 men and 93427 women Yang et al., Int J Cancer 2019

  27. Type 2 DM. NAFLD cirrhotics 352 patients withcirrhosis due to NASH, follow-up 47 months, 30 HCC Factors associated with risk of HCC based on Cox proportional hazards regression Predictorsvalidated in the larger UNOS NASH registrant cohort Yang et al. Hepatology 2019

  28. Body composition 62 patients with naïve HCC with suspected NASH were enrolled. All were curatively treated with percutaneous RFA. The visceral fat area (VFA) was determined in each patient from CT images, taken at the time of HCC diagnosis Ohkiet al. GUT 2009

  29. Metformin, insulinand HCC risk Singh et al., Am J Gastro 2013

  30. Simva/Ator vs. Prava/Rosuvastatin Swedish registers, 2005 to 2013. Simon et al. Ann Int Med 2019

  31. Physical activity and HCC Baumeisteret al., J Hepatol 2019

  32. Agenda Reason to Assess HCC Risk Parameters Underlyingdisease Fixedparameters Modifiable parameters Integration

  33. Assessment of HCC Risk

  34. Integration: example HBV

  35. Integration Obesity Type 2 Diabetes

  36. CompetitiveRisks: causesofdeath Anguloet al. Gastro 2015

  37. Conclusion

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