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Review
. 2020 May 31;12(6):1422.
doi: 10.3390/cancers12061422.

Surveillance for Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease: Universal or Selective?

Maria Corina Plaz Torres  1 , Giorgia Bodini  1 , Manuele Furnari  1 , Elisa Marabotto  1 , Patrizia Zentilin  1 , Mario Strazzabosco  2 , Edoardo G Giannini  1
Affiliations
Review

Surveillance for Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease: Universal or Selective?

Maria Corina Plaz Torres et al. Cancers (Basel). .

Abstract

Hepatocellular carcinoma (HCC), the most frequent primary liver cancer, is the sixth most common cancer, the fourth leading cause of cancer-related deaths worldwide, and accounts globally for about 800,000 deaths/year. Early detection of HCC is of pivotal importance as it is associated with improved survival and the ability to apply curative treatments. Chronic liver diseases, and in particular cirrhosis, are the main risk factors for HCC, but the etiology of liver disease is rapidly changing due to improvements in the prevention and treatment of HBV (Hepatitis B virus) and HCV (Hepatitis C virus) infections and to the rising incidence of the metabolic syndrome, of which non-alcoholic fatty liver (NAFLD) is a manifestation. NAFLD is now a recognized and rapidly increasing cause of cirrhosis and HCC. Indeed, the most recent guidelines for NAFLD management recommend screening for HCC in patients with established cirrhosis. Screening in NAFLD patients without cirrhosis is not recommended; however, the prevalence of HCC in this group of NAFLD patients has been reported to be as high as 38%, a proportion significantly higher than the one observed in the general population and in non-cirrhotic subjects with other causes of liver disease. Unfortunately, solid data regarding the risk stratification of patients with non-cirrhotic NAFLD who might best benefit from HCC surveillance are scarce, and specific recommendations in this field are urgently needed due to the increasing NAFLD epidemic, at least in Western countries. To further complicate matters, liver ultrasonography, which represents the current standard for HCC surveillance, has a decreased diagnostic accuracy in patients with NAFLD, and therefore disease-specific surveillance tools will be required for the early identification of HCC in this population. In this review, we summarize the most recent evidence on the epidemiology and risk factors for HCC in patients with NAFLD, with and without cirrhosis, and the evidence supporting surveillance for early HCC detection in these patients, reviewing the potential limitations of currently recommended surveillance strategies, and assessing data on the accuracy of potential new screening tools. At this stage it is difficult to propose general recommendations, and best clinical judgement should be exercised, based on the profile of risk factors specific to each patient.

Keywords: NAFLD; alpha-fetoprotein; liver cancer; risk factors; steatohepatitis; steatosis; ultrasound.

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Conflict of interest statement

MCPT, GB, EM, MF, PZ have no conflict of interest to declare. EGG reports advisory boards for MSD and Eisai. MS reports advisory boards for Bayer and Engitix.

Figures

Figure 1
Figure 1
Relative contributions for HCC incidence from the most frequent causes of liver disease. HCC = hepatocellular carcinoma; NASH = non-alcoholic steato-hepatitis; HBV = hepatitis B virus; HCV = hepatitis C virus.
Figure 2
Figure 2
Main risk factors for hepatocellular carcinoma (HCC) among NAFLD patients.
See this image and copyright information in PMC

References

    1. Buzzetti E., Pinzani M., Tsochatzis E.A. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD) Metabolism. 2016;65:1038–1048. doi: 10.1016/j.metabol.2015.12.012. - DOI - PubMed
    1. Marchesini G., Day C., Dufour J.F., Canbay A., Nobili V., Ratziu V., Tilg H., Roden M., Gastaldelli A., Ykijarvinen H., et al. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol. 2016;64:1388–1402. doi: 10.1016/j.jhep.2016.11.002. - DOI - PubMed
    1. Vernon G., Baranova A., Younossi Z.M. Systematic review: The epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment. Pharmacol. Ther. 2011;34:274–285. doi: 10.1111/j.1365-2036.2011.04724.x. - DOI - PubMed
    1. Younossi Z., Tacke F., Arrese M., Chander Sharma B., Mostafa I., Bugianesi E., Wai-Sun Wong V., Yilmaz Y., George J., Fan J., et al. Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology. 2019;69:2672–2682. doi: 10.1002/hep.30251. - DOI - PubMed
    1. Estes C., Razavi H., Loomba R., Younossi Z., Sanyal A.J. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123–133. doi: 10.1002/hep.29466. - DOI - PMC - PubMed

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