Journal
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
Volume 10, Issue 5, Pages 955-964Publisher
XIA & HE PUBLISHING INC
DOI: 10.14218/JCTH.2021.00586
Keywords
Epidemiology; Hepatocellular carcinoma; Non-alcoholic fatty liver disease; Risk factor; Treatment strategy
Categories
Funding
- Specific Research Project of Guangxi for Research Bases and Talents [GuiKe AD22035057]
- Natural Science Foundation of Guangxi Province [2020GXNSFAA159022]
- Bagui Scholars Programs of Guangxi Zhuang Autonomous Region [2019AQ20]
- National Natural Science Foundation of China [82060510]
- Guangxi Undergraduate Training Program for Innovation and Entrepreneurship [202110598178, 202110598073]
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The global prevalence of metabolic diseases has led to an increase in NAFLD and NAFLD-related HCC. Risk factors for NAFLD-related HCC include age, gender, metabolic comorbidities, unhealthy lifestyle habits, lack of exercise, genetic susceptibility, liver fibrosis, and degree of cirrhosis. Prevention measures include low-calorie diet, moderate-intensity exercise, treatment of metabolic comorbidities, smoking and alcohol cessation, and screening for HCC in patients with advanced NAFLD-related fibrosis or cirrhosis.
The rising global prevalence of metabolic diseases has increased the prevalence of non-alcoholic fatty liver disease (NAFLD), leading to an increase in cases of NAFLD-related hepatocellular carcinoma (HCC). To provide an updated literature review detailing epidemiology, risk factors, pathogenic pathways, and treatment strategies linked to NAFLD-related HCC, we conducted a literature search on PubMed from its inception to December 31, 2021. About 25% of the global population suffers from NAFLD. The annual incidence of HCC among NAFLD patients is approximately 1.8 per 1,000 person-years. Older age, male sex, metabolic comorbidities, unhealthy lifestyle habits (such as smoking and alcohol consumption), physical inactivity, genetic susceptibility, liver fibrosis, and degree of cirrhosis in NAFLD patients are important risk factors for NAFLD-related HCC. Therefore, low-calorie diet, moderate-intensity exercise, treatment of metabolic comorbidities, and cessation of smoking and alcohol are the main measures to prevent NAFLD-related HCC. In addition, all patients with advanced NAFLD-related fibrosis or cirrhosis should be screened for HCC. Immune suppression disorders and changes in the liver microenvironment may be the main pathogenesis of NAFLD-related HCC. Hepatic resection, liver transplantation, ablation, transarterial chemoembolization, radiotherapy, targeted drugs, and immune checkpoint inhibitors are used to treat NAFLD-related HCC. Lenvatinib treatment may lead to better overall survival, while immune checkpoint inhibitors may lead to worse overall survival. Given the specific risk factors for NAFLD-related HCC, primary prevention is key. Moreover, the same treatment may dif- fer substantially in efficacy against NAFLD-related HCC than against HCC of other etiologies.
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