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Semin Liver Dis 2015; 35(03): 304-317
DOI: 10.1055/s-0035-1562949
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: A Problem of Growing Magnitude

Christine Pocha
1   Hepatology, University Clinic for Visceral Surgery and Medicine, University of Berne, Berne, Switzerland
,
Philippe Kolly
1   Hepatology, University Clinic for Visceral Surgery and Medicine, University of Berne, Berne, Switzerland
2   Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
,
Jean-Francois Dufour
1   Hepatology, University Clinic for Visceral Surgery and Medicine, University of Berne, Berne, Switzerland
2   Hepatology, Department of Clinical Research, University of Berne, Berne, Switzerland
› Author Affiliations
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Publication History

Publication Date:
17 September 2015 (online)

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Abstract

Hepatocellular carcinoma (HCC) is a cancer with globally rising incidence. Growing evidence supports associations between metabolic syndrome and diabetes as well as obesity and HCC arising in patients with nonalcoholic fatty liver disease (NAFLD). This constitutes a problem of alarming magnitude given the rising epidemic of these conditions. The role of diabetes seems to be particularly important when associated with obesity or cirrhosis. Excess hepatic iron may be another potential risk factor for the development of NAFLD-associated HCC. In the context of NAFLD, HCC frequently develops in a not-yet cirrhotic liver. As there are no surveillance programs for these patients, diagnosis often occurs at a tumor stage beyond curative options. Clinical, tumor, and patient characteristics in NAFLD-associated HCC differ from other etiologies. Older age and cardiovascular comorbidities may limit treatment options further. The outcome in patients with NAFLD-associated early HCC is excellent and therefore aggressive treatment should be pursued in appropriate patients. Population-based prevention to reduce the culprit—NAFLD—early recognition through targeted surveillance programs in risk-stratified patients and effective treatment of HCC associated with NAFLD are urgently needed. In this review, the authors summarize the epidemiology, risk factors, features, and prevention of NAFLD-associated HCC.

Keywords

hepatocellular cancer - insulin resistance - nonalcoholic fatty liver disease - obesity
 

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