Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology Department of Medicine, University of California San Diego, La Jolla, California; Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
Gastroenterology. 2020 May;158(6):1822-1830. doi: 10.1053/j.gastro.2019.12.053. Epub 2020 Jan 30.
Nonalcoholic fatty liver disease (NAFLD) is a leading etiology for chronic liver disease with an immense public health impact and affects >25% of the US and global population. Up to 1 in 4 NAFLD patients may have nonalcoholic steatohepatitis (NASH). NASH is associated with significant morbidity and mortality due to complications of liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Recent data confirm that HCC represents the fifth most common cancer and is the second leading cause of cancer-related death worldwide, and NAFLD has been identified as a rapidly emerging risk factor for this malignancy. NAFLD-associated liver complications are projected to become the leading indication for liver transplantation in the next decade. Despite evidence that NAFLD-associated HCC may arise in the absence of cirrhosis, is often diagnosed at advanced stages, and is associated with lower receipt of curative therapy and with poorer survival, current society guidelines provide limited guidance/recommendations addressing HCC surveillance in patients with NAFLD outside the context of established cirrhosis. Limited data are presently available to guide clinicians with respect to which patients with NAFLD should undergo HCC surveillance, optimal screening tools, frequency of monitoring, and the influence of coexisting host- and disease-related risk factors. Herein we present an evidence-based review addressing HCC risk in patients with NAFLD and provide Best Practice Advice statements to address key issues in clinical management.
非酒精性脂肪性肝病 (NAFLD) 是一种主要的慢性肝病病因，具有巨大的公共卫生影响，影响超过 25%的美国和全球人口。多达 1/4 的 NAFLD 患者可能患有非酒精性脂肪性肝炎 (NASH)。由于肝硬化、肝功能失代偿和肝细胞癌 (HCC) 的并发症，NASH 与显著的发病率和死亡率相关。最近的数据证实 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，并且 NAFLD 已被确定为这种恶性肿瘤的一个迅速出现的风险因素。NAFLD 相关的肝脏并发症预计将在未来十年成为肝移植的主要指征。尽管有证据表明，NAFLD 相关的 HCC 可能在没有肝硬化的情况下发生，通常在晚期诊断，并且与接受根治性治疗的可能性较低和生存率较差相关，但目前的社会指南在没有明确肝硬化的情况下，对 NAFLD 患者的 HCC 监测提供的指导/建议有限。目前，关于哪些 NAFLD 患者应进行 HCC 监测、最佳筛查工具、监测频率以及共存的宿主和疾病相关危险因素的影响，仅有有限的数据可用于指导临床医生。在此，我们提出了一份基于证据的综述，探讨了 NAFLD 患者的 HCC 风险，并提供了最佳实践建议声明，以解决临床管理中的关键问题。
