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Review
. 2017 Apr 18;9(11):533-543.
doi: 10.4254/wjh.v9.i11.533.

Hepatocellular carcinoma in non-alcoholic steatohepatitis: Current knowledge and implications for management

George Cholankeril  1 , Ronak Patel  1 , Sandeep Khurana  1 , Sanjaya K Satapathy  1
Affiliations
Review

Hepatocellular carcinoma in non-alcoholic steatohepatitis: Current knowledge and implications for management

George Cholankeril et al. World J Hepatol. .

Abstract

With the prevalence of hepatitis C virus expected to decline, the proportion of hepatocellular carcinoma (HCC) related to non-alcoholic steatohepatitis (NASH) is anticipated to increase exponentially due to the growing epidemic of obesity and diabetes. The annual incidence rate of developing HCC in patients with NASH-related cirrhosis is not clearly understood with rates ranging from 2.6%-12.8%. While multiple new mechanisms have been implicated in the development of HCC in NASH; further prospective long-term studies are needed to validate these findings. Recent evidence has shown a significant proportion of patients with non-alcoholic fatty liver disease and NASH progress to HCC in the absence of cirrhosis. Liver resection and transplantation represent curative therapeutic options in select NASH-related HCC patients but have placed a significant burden to our healthcare resources and utilization. Currently NASH-related HCC is the fastest growing indication for liver transplant in HCC candidates. Increased efforts to implement effective screening and preventative strategies, particularly in non-cirrhotic NASH patients, are needed to reduce the future impact imposed by NASH-related HCC.

Keywords: Cirrhosis; Hepatocellular carcinoma; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Obesity.

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Conflict of interest statement

Conflict-of-interest statement: All authors have no conflicts of interest to disclose related to the research or data presented in this manuscript. There was no funding for this study. This manuscript is not being considered for publication elsewhere.

Figures

Figure 1
Figure 1
Risk factors and proposed mechanisms for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis-related hepatocellular carcinoma. The development of NAFLD and NASH-related HCC is multifactorial. Proposed pathogenic mechanisms include obesity, peripheral and hepatic insulin resistance from type 2 diabetes, increased hepatic lipid storage and lipotoxicity, EMT, genetic mutations and intestinal mibrobiota dysregulation. HCC: Hepatocellular carcinoma; EMT: Epithelial to mesenchymal transition; NAFLD: Non-alcoholic fatty liver disease; NASH: Non-alcoholic steatohepatitis; FFA: Free fatty acid; IGF: Insulin-like growth factor; LPS: Lipopolysaccharide; PNPLA3: Patatin-like phospholipase domain-containing 3; TM6SF2: Transmembrane 6 superfamily member 2.
See this image and copyright information in PMC

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