Radiologic characteristics and prognostic outcomes in non-alcoholic fatty liver disease-related versus alcohol-related hepatocellular carcinoma: a comparative cohort study

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as one of the fastest-growing etiologies of hepatocellular carcinoma (HCC), while alcohol remains a dominant cause of cirrhosis and HCC in India. Differences in tumor morphology, biological behavior, and outcomes between these two etiologies remain inadequately defined in the Indian population. This study aims to compare radiologic features and prognostic outcomes in NAFLD-related and alcohol-related HCC patients. Methods: This retrospective cohort study conducted at Apex Hospital included 50 consecutive HCC patients evaluated between September 2014 and October 2015. Etiology was classified as NAFLD (n=25) or alcohol-related liver disease (ALD) (n=25). All patients underwent contrast-enhanced computed tomography (CT) or MRI at presentation. Tumor morphology, liver imaging reporting and data system (LI-RADS) imaging features, vascular invasion, extrahepatic disease, and portal hypertension indicators were analyzed. Clinical parameters including serum alpha-fetoprotein (AFP), Child-Pugh and model for end-stage liver disease (MELD) scores, metabolic comorbidities, and treatment modalities were compared. Survival was assessed at 1 and 3 years. Results: NAFLD-HCC patients were older (mean 62 vs 54 years), had higher rates of diabetes (68% vs 24%), and more often presented with solitary large lesions (mean size 6.1 cm vs 4.2 cm). Alcohol-HCC patients showed significantly higher rates of multifocal disease (56% vs 28%) and portal hypertension markers. Portal vein thrombosis was more common in alcohol-HCC (36% vs 16%). One-year survival was higher in the NAFLD group (68% vs 40%; p