title: Hepatocellular carcinoma in Japanese patients with nonalcoholic fatty liver disease, alcoholic liver disease, and chronic liver disease of unknown etiology: report of the nationwide survey.
abstract: OBJECTIVE
  To clarify the etiology of hepatocellular carcinoma (HCC) in Japanese patients with non-viral liver disease, we performed a nationwide survey. The influence of obesity, lifestyle-related diseases, and alcohol consumption was focused on.
  
  
  METHODS
  A nationwide survey of 14,530 HCC patients was conducted in 2009. Clinical features were studied for HCC patients with nonalcoholic fatty liver disease (NAFLD-HCC; n = 292), alcoholic liver disease (ALC-HCC; n = 991), and chronic liver disease of unknown etiology (unknown HCC; n = 614). The unknown HCC was divided into two subgroups, a no alcohol intake group and a modest alcohol intake group.
  
  
  RESULTS
  ALC-HCC accounted for 7.2% of all HCC, followed by unknown HCC (5.1%) and NAFLD-HCC (2.0%). The characteristics of these three groups were clearly different (median age was 72 years for NAFLD-HCC, 68 years for ALC-HCC, and 73 years for unknown HCC, p < 0.01; female gender was 38, 4, and 37%, respectively, p < 0.01). Obesity and lifestyle-related diseases were significantly more frequent in NAFLD-HCC than in ALC-HCC and unknown HCC. The no alcohol intake subgroup of unknown HCC showed female predominance (58%) and was older, without a high prevalence of obesity and lifestyle-related diseases. In contrast, the modest alcohol intake subgroup showed the same trends regarding gender, body mass index, prevalence of lifestyle-related diseases, and liver function as the ALC-HCC group.
  
  
  CONCLUSIONS
  The clinical features of ALC-HCC, NAFLD-HCC, and unknown HCC were clearly different. Modest intake of alcohol might have a more significant role in hepatic carcinogenesis than is presently thought.
authors: Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors: Katsutoshi
authors: K
authors: Tokushige
authors: Etsuko
authors: E
authors: Hashimoto
authors: Yoshinori
authors: Y
authors: Horie
authors: Makiko
authors: M
authors: Taniai
authors: Susumu
authors: S
authors: Higuchi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors