title: Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Ospedale S. Giovanni Battista, University of Turin, Turin, Italy. ebugianesi@contacta.it
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.forename: Nicola
authors.initials: N
authors.lastname: Leone
authors.forename: Ester
authors.initials: E
authors.lastname: Vanni
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Franco
authors.initials: F
authors.lastname: Brunello
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Musso
authors.forename: Paolo
authors.initials: P
authors.lastname: De Paolis
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: 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
chemical_list: D000637:Transaminases