Nonalcoholic Fatty Liver Disease Is Correlate With Cryptogenic Hepatocellular Carcinoma: A Case-Control Study

Background: Fatty liver is the most frequent chronic liver disease.Fatty liver-related hepatocellular carcinoma may be the origin of cryptogenic liver cancer.We aimed to perform the correlation between fatty liver and steatohepatitis in cryptogenic hepatocellular cancer.Methods: We retrospectively analyzed the records of 2086 primary hepatic carcinoma (HCC) patients in the District, Lahore from 2007 to 2020.A total of 330 cases were screened out with pathologic reports.Among the 330 cases 183 cases of hepatitis B, 14 cases of hepatitis C, 33 cases of alcoholic liver, 20 cases of cholangiocarcinoma, 15 cases of metastatic carcinoma, 2 cases of autoimmune liver disease were ruled out, and 63 cases without definite etiology were inclusion analysis.49 patients diagnosed with intrahepatic cholangiocarcinoma (CC) during the same period were also included as a comparison group.A total of 112 cases were included in this study.We delved into the demographic, clinical, and pathological characteristics of patients.Liver pathological films were interpreted by a pathologist(LLL)and a hepatologist who knows liver pathology (ZYT).The pathological films around liver cancer were scored by the NAS method.The standard NAS score 5 was classified as steatohepatitis and non-alcoholic simple fatty liver disease was defined as those without intralobular inflammation, ballooning degeneration, and fibrosis but with hepatic steatosis>5%.The differences between the two groups were analyzed.Results: Pathological slides were not found in 2 of 112 cases (both in the HCC group).Among the pathological slides of 110 patients, 12 had no normal tissue around the tumor (10 HCC, 2 CC).Of the remaining 98 cases(51 HCC,47 CC), 31 (26.7%) had a fatty liver background, including 24 patients with HCC (48%, 24/50) and 7 patients with CC (14.58%, 7/48), with statistically significant differences (P < 0.001).There were 16 cases of steatohepatitis, 14 cases in the HCC group (28 %, 14/50), and 2 cases in the CC group (4.17%,2/48), with statistically significant differences (P < 0.001).NAS score in the non-tumor liver was a statistically significant difference in HCCs and CCs groups (p < 0.0001), A statistically significant difference in NAS score between HCCs