title: Hepatocellular carcinoma in patients with non-alcoholic fatty liver disease.
abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and represents an increasingly important etiology of hepatocellular carcinoma (HCC) with annual cumulative incidence rates ranging from 2% to 12% in cohorts of NAFLD cirrhosis. While the risk of progression of NAFLD to HCC remains higher among patients with fibrosis or cirrhosis, an increasing amount of literature describes NAFLD-HCC as a disease that can occur in the absence of cirrhosis. Efforts to characterize the pathogenesis of NAFLD-HCC have suggested mechanisms that strongly associate with states of hyperinsulinemia and chronic inflammation, cellular mechanisms including adaptive immune responses and hepatic progenitor cell populations, and genetic polymorphisms including mutations of PNPLA3. Current literature describes NAFLD-HCC mostly as a disease of late presentation with lower rates of receipt of curative therapy and worse prognosis. However, a growing body of evidence has reported comparable and potentially more favorable disease-free and overall survival rates among patients with NAFLD-HCC after receipt of curative treatment. This review summarizes current evidence of epidemiology, pathophysiology, disease presentation, demand and receipt of curative therapy, post-treatment outcomes, and overall survival of NAFLD-associated HCC.
authors.affiliation: Carrie R Wong, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, United States.
authors.forename: Carrie R
authors.initials: CR
authors.lastname: Wong
authors.affiliation: Carrie R Wong, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, United States.
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
authors.affiliation: Carrie R Wong, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, United States.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lim
mesh_terms: D052242:Adiponectin / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D007107:Immune System; D007249:Inflammation; D008049:Lipase / Q000235:genetics; D008099:Liver / Q000378:metabolism / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008565:Membrane Proteins / Q000235:genetics; D009154:Mutation; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D011110:Polymorphism, Genetic; D011184:Postoperative Period; D012307:Risk Factors; D013234:Stem Cells / Q000166:cytology; D015996:Survival Rate; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent
chemical_list: D052242:Adiponectin; D008049:Lipase; D008565:Membrane Proteins; C533682:PNPLA3 protein, human; D000217:Acyltransferases; D054512:Phospholipases A2, Calcium-Independent
keywords: Fatty liver; Hepatocellular carcinoma; Liver cancer; Liver cirrhosis; Nonalcoholic steatohepatitis