Wong Sui-Weng, Ting Yi-Wen, Chan Wah-Kheong
Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia.
JGH Open. 2018 Jul 17;2(5):235-241. doi: 10.1002/jgh3.12070. eCollection 2018 Oct.
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related mortality worldwide. Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver pathology that is characterized by the excessive accumulation of fat in the liver attributable to overnutrition and is strongly associated with the metabolic syndrome. Non-alcoholic steatohepatitis is the more severe form of NAFLD that is defined histologically by the presence of lobular inflammation and hepatocyte ballooning. Non-alcoholic steatohepatitis patients have a greater tendency to develop advanced liver fibrosis, cirrhosis, and HCC. This review focuses on the epidemiology of NAFLD-related HCC and its implications. NAFLD has been estimated to contribute to 10-12% of HCC cases in Western populations and 1-6% of HCC cases in Asian populations. NAFLD-related HCC is expected to increase in Asian populations, in line with the increased prevalence of NALFD similar to that of Western populations in recent years. The increasing burden of NAFLD-related HCC over time has been demonstrated in studies from both Western and Asian populations. Certain factors such as ethnicity, obesity, and diabetes mellitus appear to have an incremental effect on the risk of developing HCC among NAFLD patients. The difficulty in identifying NAFLD patients with cirrhosis and the possibility of HCC developing in noncirrhotic NAFLD patients are challenges that need to be addressed. Further understanding of these gaps may contribute to better surveillance strategies for the early detection of HCC in NAFLD patients to reduce the mortality and improve the survival of these patients.
肝细胞癌（HCC）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）涵盖一系列肝脏病理状态，其特征是由于营养过剩导致肝脏脂肪过度蓄积，且与代谢综合征密切相关。非酒精性脂肪性肝炎是NAFLD更严重的形式，在组织学上由小叶炎症和肝细胞气球样变来定义。非酒精性脂肪性肝炎患者发生晚期肝纤维化、肝硬化和HCC的倾向更大。本综述重点关注NAFLD相关HCC的流行病学及其影响。据估计，在西方人群中，NAFLD导致10% - 12%的HCC病例，在亚洲人群中导致1% - 6%的HCC病例。随着近年来NAFLD患病率的增加，与西方人群类似，预计亚洲人群中与NAFLD相关的HCC也会增加。西方和亚洲人群的研究均表明，随着时间推移，与NAFLD相关的HCC负担不断增加。某些因素，如种族、肥胖和糖尿病，似乎对NAFLD患者发生HCC的风险有累加作用。识别肝硬化的NAFLD患者存在困难，且非肝硬化的NAFLD患者也有可能发生HCC，这些都是需要解决的挑战。进一步了解这些差距可能有助于制定更好的监测策略，以便在NAFLD患者中早期发现HCC，从而降低死亡率并提高这些患者的生存率。
