Hepatocellular carcinoma in patients with nonalcoholic seatohepatitis

Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Journal of Gastroenterology (Impact Factor: 4.52). 01/2009; 44 Suppl 19(S19):89-95. DOI: 10.1007/s00535-008-2262-x
Source: PubMed


There have been few reports on hepatocellular carcinoma (HCC) in nonalcoholic steatohepatitis (NASH) and the natural history of NASH. Accordingly, we assessed the clinical features of HCC in NASH, the risk factors for HCC, and natural history of NASH with advanced fibrosis.
There were 34 NASH patients with HCC and 348 NASH patients without HCC. To clarify the clinical features of NASH patients with HCC and to determine the risk factors for HCC, we compared NASH patients with HCC with those without HCC. Univariate and multivariate logistic regression models were used for statistical analysis. A prospective cohort study of the outcomes of 137 NASH with advanced fibrosis was started in 1990. The impact of baseline risk factors on the development of HCC and survival was evaluated by Cox regression analysis.
In total, 88% of patients with HCC had advanced fibrosis, with a median age of 70 years. Older age, low level of AST, low grade of histological activity, and advanced stage of fibrosis were risk factors for HCC. A prospective cohort study showed that the 5-year cumulative incidence of HCC was 7.6%, and the 5-year survival rate was 82.8%. HCC was the leading cause of death.
The present study confirmed that older age and advanced fibrosis were important risk factors for HCC, and that HCC was the major cause of mortality in NASH patients with advanced fibrosis. Regular screening for HCC is thus extremely important for NASH patients with advanced fibrosis.

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Available from: Katsutoshi Tokushige, Nov 02, 2015
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    • "Furthermore, NAFLD encompasses a wide spectrum of liver damages; thus, there is a lack of absolute positive or negative markers to study the disease progression [15] and the onset of HCC [16]. Moreover, prognosis of HCC, which is considered a multifactorial malignancy, is not solely dependent on tumour burden but is also adversely influenced by impaired liver function secondary to the underlying pathogenic condition [1] [10] [16]. Ideal biomarkers to follow the evolution of NAFLD to HCC should possess high specificity and sensitivity. "
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    ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is a metabolic-related disorder ranging from steatosis to steatohepatitis, which may progress to cirrhosis and hepatocellular carcinoma (HCC). The influence of NAFLD on HCC development has drawn attention in recent years. HCC is one of the most common malignant tumors and the third highest cause of cancer-related death. HCC is frequently diagnosed late in the disease course, and patient's prognosis is usually poor. Early diagnosis and identification of the correct stage of liver damage during NAFLD progression can contribute to more effective therapeutic interventions, improving patient outcomes. Therefore, scientists are always searching for new sensitive and reliable markers that could be analysed through minimally invasive tests. MicroRNAs are short noncoding RNAs that act as posttranscriptional regulators of gene expression. Several studies identified specific miRNA expression profiles associated to different histological features of NAFLD. Thus, miRNAs are receiving growing attention as useful noninvasive diagnostic markers to follow the progression of NAFLD and to identify novel therapeutic targets. This review focuses on the current knowledge of the miRNAs involved in NAFLD and related HCC development, highlighting their diagnostic and prognostic value for the screening of NAFLD patients.
    03/2014; 2014(5):741465. DOI:10.1155/2014/741465
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    • "Second, the HCC diagnosis is generally performed during the first visit of the patient and the tumor is often multifocal with large dimensions that limit the available treatments [6]. Third, patients are older and have more comorbidities at the time of HCC diagnosis, which may reduce the applicability of potentially curative therapies, such as liver transplantation [11]. These findings justify a surveillance program mainly after the establishment of cirrhosis. "
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    ABSTRACT: Hepatocellular carcinoma (HCC) incidence is increasing worldwide in recent years. Most HCC cases develop in the presence of advanced chronic liver disease related to chronic hepatitis C virus (HCV) infection, chronic hepatitis B (HBV) infection, and alcohol abuse. Approximately 15-50% of HCC cases are classified as idiopathic, suggesting that other risk factors are responsible for its rising incidence. Recent studies suggest that nonalcoholic fatty liver disease (NAFLD) can be associated with these "idiopathic" cases. NAFLD progresses slowly and can develop into liver cirrhosis, liver failure, and HCC. In the last few years, NAFLD has received more attention because of its high prevalence worldwide.
    03/2014; 2014(18):106247. DOI:10.1155/2014/106247
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    • "It was found that children with tyrosinemia are at high risk of liver transplantation as beyond age of two years the incidence of HCC increases substantially [78]. A couple of familiar conditions or diseases inherited as polygenic traits, for example, autoimmune hepatitis (AIH), hypothyroidism and type 2 diabetes may also contribute to HCC development [79]. The genetic heterogeneity that is cause by a number of unlinked single gene defects may increase the susceptibility to HCC [80]. "
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    ABSTRACT: Hepatocellular carcinoma (HCC) is a deadly and emerging disease leading to death in Asian countries. High hepatitis B virus (HBV) load and chronic hepatitis B (CHB) infection increase the risk of developing HCC. HBV is a DNA virus that can integrate DNA into host genome thereby increase the yield of transactivator protein HBxAg that may deregulate many pathways involving in metabolism of cells. Several monogenic and polygenic risk factors are also involved in HCC development. This review summarizes the mechanism involved in HCC development and discusses some promising therapies to make HCC curative.
    BioMed Research International 08/2013; 2013:810461. DOI:10.1155/2013/810461 · 1.58 Impact Factor
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