Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma.
OBJECTIVE
Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis; whether NASH plays also a role in the development of hepatocellular carcinoma (HCC) is unknown.


METHODS
Among 641 cirrhosis-associated HCCs, we retrospectively identified 44 patients with cryptogenic cirrhosis (CC). Of these, 23 were actively followed up and were compared in a case-control study with viral- and alcohol-associated HCC. Family and personal history of diabetes, hypertension, coronary heart disease, dyslipidemia, obesity, and biochemical data were compared between groups. Iron status and presence of mutations in the HFE gene of familiar hemochromatosis were also determined.


RESULTS
Family history was not different in relation to etiology. The prevalence of obesity and diabetes was significantly higher in patients with CC. Although liver function was similar, CC patients had higher glucose, cholesterol, and triglyceride plasma levels, increased parameters of insulin resistance, and lower aminotransferase levels. Iron status and prevalence of mutations in the HFE gene did not differ. Logistic regression analysis identified in sequence hypertriglyceridemia, diabetes, and normal aminotransferases as independent factors associated with HCC arising in CC.


CONCLUSIONS
Features suggestive of NASH are more frequently observed in HCC arising in patients with CC than in age- and sex-matched HCC patients of well-defined viral or alcoholic etiology. HCC may represent a late complication of NASH-related cirrhosis.
Bugianesi
Elisabetta
E
Department of Gastroenterology, Ospedale S. Giovanni Battista, University of Turin, Turin, Italy. ebugianesi@contacta.it
Leone
Nicola
N
Vanni
Ester
E
Marchesini
Giulio
G
Brunello
Franco
F
Carucci
Patrizia
P
Musso
Alessandro
A
De Paolis
Paolo
P
Capussotti
Lorenzo
L
Salizzoni
Mauro
M
Rizzetto
Mario
M
D000368:Aged; D000437:Alcoholism / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000821:virology; D016022:Case-Control Studies; D048909:Diabetes Complications; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications; D008103:Liver Cirrhosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000637:Transaminases / Q000378:metabolism
D000637:Transaminases