The Current View of Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and can develop into hepatocellular carcinoma (HCC). The incidence of NAFLD-related HCC, which is accompanied by life-threatening complications, is increasing. Advanced fibrosis and lifestyle-related and metabolic comorbidities, especially obesity and diabetes mellitus, are associated with HCC development. However, HCC is also observed in the non-cirrhotic liver. Often, diagnosis is delayed until the tumor is relatively large and the disease is advanced; an effective screening or surveillance method is urgently required. Recently, the NAFLD/nonalcoholic steatohepatitis (NASH) guidelines of Japan were revised to incorporate new strategies and evidence for the management and surveillance of NAFLD/NASH. Fibrosis must be tested for noninvasively, and the risk of carcinogenesis must be stratified. The treatment of lifestyle-related diseases is expected to reduce the incidence of NAFLD and prevent liver carcinogenesis.

Keywords: hepatocellular carcinoma; nonalcoholic fatty liver disease; prevalence; prognosis; surveillance.

Figure 1

The algorithm for hepatocellular carcinoma screening and surveillance contained in the revised Japanese guidelines [6]. AST, aspartate aminotransferase; ALT, alanine aminotransferase; BMI, body mass index; FIB-4, Fibrosis-4; NFS, nonalcoholic fatty liver disease fibrosis score; IFG, impaired fasting glucose; NAFLD, nonalcoholic fatty liver disease; HCC, hepatocellular carcinoma; US, ultrasonography.