AM and A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
AM and A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Lancet Gastroenterol Hepatol. 2016 Oct;1(2):156-164. doi: 10.1016/S2468-1253(16)30018-8. Epub 2016 Sep 8.
Hepatocellular carcinoma is the fifth most common cancer and the second leading cause of cancer-related death worldwide. Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis have been identified as emergent risk factors for this primary liver cancer. Incidence of NAFLD is increasing as a consequence of the epidemic spread of metabolic syndrome, which can result in progressive liver disease, leading to cirrhosis and its complications. Most data about the prevalence and incidence of hepatocellular carcinoma in patients with NAFLD are from a few population and cohort studies; its incidence is increasing and it is likely to become a leading indication for liver transplantation, especially in industrialised countries. In patients with NAFLD, hepatocellular carcinoma can arise in the context of non-cirrhotic liver, suggesting a specific carcinogenic pathway. Pathology studies have also described steatohepatitic hepatocellular carcinoma as a specific histological variant. NAFLD is underdiagnosed as causative liver disease, and patients are often diagnosed with hepatocellular carcinoma in the advanced stage because of the absence of efficient surveillance policies in this patient population. Management of hepatocellular carcinoma in patients with NAFLD is also complicated by comorbidities, mainly cardiac disease and diabetes, which negatively affect eligibility for radical treatments, including hepatic resection and, especially, liver transplantation. Finally, the effect of hepatocellular carcinoma treatments on postoperative morbidity, mortality, and disease-free survival remains to be precisely defined.
肝细胞癌是全球第五大常见癌症，也是癌症相关死亡的第二大主要原因。非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎已被确定为这种原发性肝癌的新兴危险因素。由于代谢综合征的流行，NAFLD 的发病率正在增加，这可能导致进行性肝病，导致肝硬化及其并发症。大多数关于 NAFLD 患者中肝细胞癌的患病率和发病率的数据来自少数人群和队列研究；其发病率正在增加，并且可能成为肝移植的主要指征，尤其是在工业化国家。在 NAFLD 患者中，肝细胞癌可以在非肝硬化肝脏的背景下发生，提示存在特定的致癌途径。病理学研究还将脂肪性肝炎性肝细胞癌描述为一种特定的组织学变异型。NAFLD 被误诊为导致肝脏疾病的原因，由于缺乏有效的监测政策，这些患者人群往往在晚期被诊断为肝细胞癌。NAFLD 患者的肝细胞癌的管理也因合并症而变得复杂，主要是心脏病和糖尿病，这对包括肝切除术和特别是肝移植在内的根治性治疗的资格产生负面影响。最后，肝细胞癌治疗对术后发病率、死亡率和无病生存率的影响仍需精确确定。
