From Non-Alcoholic Steatohepatitis (NASH) to Hepatocellular Carcinoma (HCC): Epidemiology, Incidence, Predictions, Risk Factors, and Prevention

Abstract

Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. The incidence of NASH is projected to increase by up to 56% over the next 10 years. There is growing epidemiological evidence that NAFLD has become the fastest-growing cause of hepatocellular carcinoma (HCC) in industrialized countries. The annual incidence of HCC varies between patients with NASH cirrhosis and patients with noncirrhotic NAFLD. In this review, NAFLD/NASH-associated HCC will be described, including its epidemiology, risk factors promoting hepatocarcinogenesis, and management of HCC in patients with obesity and associated metabolic comorbidities, including preventive strategies and therapeutic approaches to address this growing problem.

Machine Learning-Based Assessment of Survival and Risk Factors in Non-Alcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma for Optimized Patient Management

“…These patients also present a higher degree of fibrosis and the possibility of progressing to cirrhosis in proportion to BMI and abdominal circumference. This results from hepatic immune activation, leading to secondary inflammation and fibrosis, heightening the risk of HCC development [ 58 , 59 ]. Additionally, obesity also shows an association and a worse prognosis among patients who consume alcohol.…”

Global Burden of Pancreatic Cancer Attributable to High Body-Mass Index in 204 Countries and Territories, 1990–2019

“…Since obesity was identified as an important risk factor for many cancers, numerous studies were conducted to evaluate how effective the therapies for cancer prevention (surgical or pharmacological) against obesity proved to be [49,50]. Weight reduction (which correlates with a low-fat and -sugar diet and a high dietary intake of fresh fruit and vegetables, and their associated nutrients like fiber, antioxidants, and polyphenols) together with a healthy lifestyle and regular exercise may contribute to the prevention of pancreatic cancer [50,51].…”

Namodenoson at the Crossroad of Metabolic Dysfunction-Associated Steatohepatitis and Hepatocellular Carcinoma

“…In patients with MASLD/MASH, HCC can develop with or without existing cirrho- In patients with MASLD/MASH, HCC can develop with or without existing cirrhosis, although liver cirrhosis is the strongest predictor for HCC development. The annual incidence of HCC in patients with cirrhotic MASH is up to 12% [29]. HCC develops in these patients due to the combination of insulin resistance, damage to the mitochondria from the accumulation of fat, inflammation, and chronic dysregulation of cytokines [29].…”

“…The annual incidence of HCC in patients with cirrhotic MASH is up to 12% [29]. HCC develops in these patients due to the combination of insulin resistance, damage to the mitochondria from the accumulation of fat, inflammation, and chronic dysregulation of cytokines [29]. Despite advances in HCC therapies, including the availability of immune checkpoint inhibitors, further research is greatly needed, as the overall survival with the current systemic therapies is limited (average 5-year survival as low as 2.5% for advanced metastatic disease) [30,31].…”