Hepatocellular carcinoma in Japanese patients with nonalcoholic fatty liver disease, alcoholic liver disease, and chronic liver disease of unknown etiology: report of the nationwide survey

Abstract

The clinical features of ALC-HCC, NAFLD-HCC, and unknown HCC were clearly different. Modest intake of alcohol might have a more significant role in hepatic carcinogenesis than is presently thought.

Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

“…According to a nationwide retrospective survey on the etiology of liver cirrhosis, NAFLD accounts for 2.1 % of all cirrhosis in Japan [24]. NAFLD/NASH-related HCC accounts for 10-24 % of all HCC in Western countries and 2-5 % in Japan [25]. Pediatric NAFLD is also related to obesity and metabolic syndromes.…”

Progression and Natural History of Nonalcoholic Fatty Liver Disease in Adults

“…A French study analyzed a cohort of 31 patients with HCC with MetS as the only risk factor for liver disease and found mild or no fibrosis in most cases, compared with those harboring HCC associated with an overt cause of liver disease (65% vs 26%, P<.0001). 38 The absence of cirrhosis was further confirmed in 38% of Japanese patients 41 and in one-third of patients from North East England with NAFLD-related HCC. 41 As patients without cirrhosis are not in surveillance programs, most (62.3%) presented symptomatically with larger tumors, and their median survival was just 7.2 months.…”

“…38 The absence of cirrhosis was further confirmed in 38% of Japanese patients 41 and in one-third of patients from North East England with NAFLD-related HCC. 41 As patients without cirrhosis are not in surveillance programs, most (62.3%) presented symptomatically with larger tumors, and their median survival was just 7.2 months. 39 In conclusion, HCC in NAFLD should not be underestimated for several reasons.…”

Nonalcoholic Fatty Liver Disease (NAFLD) and Hepatocellular Carcinoma: How Common?

“…Another limitation is the potential for reverse causality, by which some of the risk factors (e.g., diabetes or BMI) are affected by the development of HCC or the preceding cirrhosis. Our search found at least 9 studies performed in Asia (n=7 in Japan), 6 in Europe, and 7 in the USA [8,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]44•, 45•] (Table 1C). All compared a case group with HCC attributed to NASH/NAFLD or to CC presumptively NAFLD related, with at least 1 control group, typically with HCC attributed to another cause of liver disease (n=19); though 2 had only NASHrelated cirrhosis controls without HCC as their sole comparison or control group.…”