Hepatocellular carcinoma in nonalcoholic fatty liver cirrhosis and alcoholic cirrhosis: risk factor analysis in liver transplant recipients

Background Cirrhosis and hepatocellular carcinoma (HCC) evolving from nonalcoholic fatty liver disease (NAFLD) are being increasingly documented. However, clinicopathologic studies to support this are inadequate. Also, the pathogenesis of HCC in alcoholic cirrhosis (ALC) in which the pathologic and clinical features are very similar to those of nonalcoholic fatty liver cirrhosis (NAFLC) is unknown. Methods A clinicomorphologic study on 47 confirmed NAFLC cases, with HCC in eight of them and 75 confirmed ALC cases with HCC in five from among orthotopic liver transplant recipients, was performed. Results Patients with NAFLC were older by about 9 years than those with ALC. HCC in NAFLC occurred almost exclusively in men. The presence of NAFLD risk factors, obesity and diabetes both together, was significantly higher in NAFLC than in ALC cases and within the latter, in those with HCC than in those without HCC, whereas in the NAFLC group, this was no different between those with and without the tumor. The steatohepatitic variant of HCC, consistently accompanied by similar histologic changes in the nontumor part of liver, which is a histologic hallmark of association with NAFLC risk factors, was much more frequent in the NAFLC group compared with the ALC group. Conclusion Hepatic alterations induced by risk factors of NAFLD not only have cirrhogenic but also, very likely, a carcinogenic effect. The incidence of HCC in NAFLC seems higher than in ALC. These findings and their bases need to be established by further studies. Eur J Gastroenterol Hepatol 24:840-848 (c) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.