Nonalcoholic steatohepatitis and hepatocellular carcinoma: Brazilian survey.
OBJECTIVE
The majority of cases of hepatocellular carcinoma have been reported in individuals with cirrhosis due to chronic viral hepatitis and alcoholism, but recently, the prevalence has become increasingly related to nonalcoholic steatohepatitis around the world. The study aimed to evaluate the clinical and histophatological characteristics of hepatocellular carcinoma in Brazilians' patients with nonalcoholic steatohepatitis at the present time.


METHODS
Members of the Brazilian Society of Hepatology were invited to complete a survey regarding patients with hepatocellular carcinoma related to nonalcoholic steatohepatitis. Patients with a history of alcohol intake (>20 g/day) and other liver diseases were excluded. Hepatocellular carcinoma diagnosis was performed by liver biopsy or imaging methods according to the American Association for the Study of Liver Diseases' 2011 guidelines.


RESULTS
The survey included 110 patients with a diagnosis of hepatocellular carcinoma and nonalcoholic fatty liver disease from nine hepatology units in six Brazilian states (Bahia, Minas Gerais, Rio de Janeiro, São Paulo, Paraná and Rio Grande do Sul). The mean age was 67±11 years old, and 65.5% were male. Obesity was observed in 52.7% of the cases; diabetes, in 73.6%; dyslipidemia, in 41.0%; arterial hypertension, in 60%; and metabolic syndrome, in 57.2%. Steatohepatitis without fibrosis was observed in 3.8% of cases; steatohepatitis with fibrosis (grades 1-3), in 27%; and cirrhosis, in 61.5%. Histological diagnosis of hepatocellular carcinoma was performed in 47.2% of the patients, with hepatocellular carcinoma without cirrhosis accounting for 7.7%. In total, 58 patients with cirrhosis had their diagnosis by ultrasound confirmed by computed tomography or magnetic resonance imaging. Of these, 55% had 1 nodule; 17%, 2 nodules; and 28%, ≥3 nodules.


CONCLUSIONS
Nonalcoholic steatohepatitis is a relevant risk factor associated with hepatocellular carcinoma in patients with and without cirrhosis in Brazil. In this survey, hepatocellular carcinoma was observed in elevated numbers of patients with steatohepatitis without cirrhosis.
Universidade Federal da Bahia, Departamento de Medicina - Serviço de Gastro-Hepatologia, Salvador/BA, Brazil.
Helma P
HP
Cotrim
Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brazil.
Claudia P
CP
Oliveira
Universidade Federal do Rio de Janeiro, Departamento de Clínica Médica, Rio de Janeiro/RJ, Brazil.
Henrique Sérgio M
HS
Coelho
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna, Serviço de Gastroenterologia, Porto Alegre/RS, Brazil.
Mario R
MR
Alvares-da-Silva
Hospital Federal dos Servidores do Estado, Serviço de Clinica Médica, Setor de Hepatologia, Rio de Janeiro/RJ, Brazil.
Leticia
L
Nabuco
Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brazil.
Edison Roberto
ER
Parise
Hospital Nossa Senhora das Graças. Serviço de Gastroenterologia, Hepatologia e Transplante Hepático, Curitiba/PR, Brazil.
Claúdia
C
Ivantes
Universidade de São Paulo, Faculdade de Medicina de Ribeirao Preto, Divisao de Gastroenterologia, Departamento de Clinica Medica, Ribeirão Preto/SP, Brazil.
Ana Lc
AL
Martinelli
Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte/MG, Brazil.
João
J
Galizzi-Filho
Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo/SP, Brazil.|Members of the NAFLD - HCC Survey - Sociedade Brasileira de Hepatologia (SBH), São Paulo/SP, Brazil.
Flair J
FJ
Carrilho
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors