Non‐alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis

• Published in: International journal of cancer 2011-05, Vol.128 (10), p.2436-2443
• Main Authors: Ertle, Judith, Dechêne, Alexander, Sowa, Jan‐Peter, Penndorf, Volker, Herzer, Kerstin, Kaiser, Gernot, Schlaak, Jörg F., Gerken, Guido, Syn, Wing‐Kin, Canbay, Ali
• Format: Article
• Language: English
• Subjects: Aged; Alcoholic beverages; Biological and medical sciences; BMI; Cancer; Carcinoma, Hepatocellular - pathology; Cardiovascular disease; Cirrhosis; Coronary artery; Coronary artery disease; Developed countries; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Dyslipidemia; Fatty liver; Fatty Liver - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Heart diseases; Hepatitis; Hepatocellular carcinoma; Humans; Incidence; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - pathology; Liver diseases; Liver Neoplasms - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical research; Medical sciences; Metabolic syndrome; Metabolism; NAFLD; NASH; Other diseases. Semiology; Risk factors; Tumors
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.25797

Non‐alcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries, and accumulating evidence suggests it as the hepatic manifestation of the metabolic syndrome (MS). Although the published prevalence of hepatocellular carcinoma (HCC) is low in NAFLD/NASH patients, most of these data have been derived from areas endemic for viral hepatitis. We recruited 162 adults with HCC between February 2007 and March 2008, investigated the underlying etiologies and determined the prevalence of the MS and related features within each group. Patients with NAFLD/NASH‐associated HCC exhibited a higher prevalence of metabolic features (Type 2 diabetes mellitus, hypertension, dyslipidemia, coronary artery disease) compared to non‐NAFLD/NASH‐HCC. Intriguingly, a significant number (41.7%; p < 0.005) of individuals with NAFLD/NASH‐HCC had no evidence of cirrhosis. Patients with alcohol‐induced liver disease also displayed many features (14/19, 73.7%) of the MS, although, in contrast to NAFLD/NASH‐HCC, alcohol‐associated HCC was highly associated with cirrhosis (95.0%; p = 0.064). NAFLD/NASH as the hepatic entity of the MS may itself pose a risk factor for HCC, even in the absence of cirrhosis. The MS may also promote development of HCC among those with alcoholic liver disease. Increased awareness of liver manifestations in the MS may instigate early interventions against developing HCC.