title: Clinical and pathological progression of non-alcoholic steatohepatitis to hepatocellular carcinoma.
abstract: OBJECTIVE
  Non-alcoholic steatohepatitis (NASH) can progress to hepatocellular carcinoma (HCC). We aimed to examine the clinical and pathological course of how NASH progresses to HCC.
  
  
  METHODS
  In this retrospective multicenter study conducted in Japan, we examined 19 patients (53% female), who had been previously diagnosed with histologically proven NASH and developed HCC during the follow-up period. The median age of the patients at the time of initial diagnosis of NASH was 65 years.
  
  
  RESULTS
  NASH progressed to HCC after a median follow-up period of 3.8 years (range: 0.5-11.6 years). All patients had been identified as having HCC during screening, which included 12 patients assessed by ultrasound, four patients assessed with computerized tomography, two patients that underwent serum des-γ-carboxy prothrombin testing and one patient that underwent serum α-fetoprotein testing. The median diameter of HCC tumors was 1.8 cm (range: 0.8-3.0 cm). The majority of patients (n = 13; 68%) presented with only one HCC tumor. The stage of liver fibrosis was significantly more advanced at the time of diagnosis of HCC than at the time of initial diagnosis of NASH, whereas there were no significant differences in the degree of steatosis.
  
  
  CONCLUSIONS
  Screening for HCC with imaging is necessary not only in NASH patients with advanced fibrosis, but also in those with less advanced forms of fibrosis, particularly if they are old men. Liver fibrosis progresses to a more advanced stage during the development of HCC in NASH patients.
authors.affiliation: Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kagoshima, Japan.
authors.forename: Kohichiroh
authors.initials: K
authors.lastname: Yasui
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Tokushige
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Toshihide
authors.initials: T
authors.lastname: Shima
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kanbara
authors.forename: Toshiji
authors.initials: T
authors.lastname: Saibara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uto
authors.forename: Shiro
authors.initials: S
authors.lastname: Takami
authors.forename: Miwa
authors.initials: M
authors.lastname: Kawanaka
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Komorizono
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue