Campani Claudia, Bensi Carolina, Milani Stefano, Galli Andrea, Tarocchi Mirko
Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
J Hepatocell Carcinoma. 2020 Jul 30;7:107-116. doi: 10.2147/JHC.S252506. eCollection 2020.
Global prevalence of non-alcoholic fatty liver disease (NAFLD) has been growing in the last decades, especially in western countries, due to increased prevalence of diabetes, obesity or other components of metabolic syndrome. NAFLD recently became an important cause of hepatocellular carcinoma (HCC), even in non-cirrhotic patients. Patients with HCC-NAFLD are usually older, with more morbidities (especially cardiovascular diseases and metabolic disorders) and have advanced disease at the diagnosis due to the absence of surveillance, which is considered not cost-effective in patients without advanced fibrosis/cirrhosis, given the large prevalence of NAFLD in the general population. For these reasons, patients with HCC-NAFLD unlikely underwent curative treatments, and have been reported to have lower overall survival (OS) compared to individuals with HCC related to other aetiologies. However, this difference is not confirmed by data of patient subgroups who received curative treatment. In our review, we selected studies published over the past 8 years that analyse characteristics and outcomes of HCC-NAFLD patients who underwent surgery with the aim of identifying features that could predict outcomes and potential selection criteria. All the studies confirm that patients with HCC-NAFLD are older, with many comorbidities and that HCC occurs frequently even in non-cirrhotic livers. There is no agreement about intraoperative and perioperative complications. Regarding outcomes, all papers agree that patients with HCC in NAFLD who undergo surgery have a better OS compared to other aetiologies. Summarizing, surgery is a good curative option for patients with HCC-NAFLD, perhaps even better than transplantation in terms of OS. In this group of patients, it seems to be essential to evaluate cardio-pulmonary and general operative risk, in addition to the normal risk assessment related to liver function to avoid an underestimation, especially for patients without severe underlying fibrosis.
在过去几十年中，非酒精性脂肪性肝病（NAFLD）的全球患病率一直在上升，尤其是在西方国家，这归因于糖尿病、肥胖症或代谢综合征其他成分患病率的增加。NAFLD最近成为肝细胞癌（HCC）的一个重要病因，即使在非肝硬化患者中也是如此。HCC-NAFLD患者通常年龄较大，合并症较多（尤其是心血管疾病和代谢紊乱），并且由于缺乏监测，在诊断时病情已发展到晚期。鉴于NAFLD在普通人群中的高患病率，对于没有晚期纤维化/肝硬化的患者，监测被认为不具有成本效益。由于这些原因，HCC-NAFLD患者不太可能接受根治性治疗，并且据报道与其他病因导致的HCC患者相比，其总生存期（OS）较低。然而，接受根治性治疗的患者亚组数据并未证实这种差异。在我们的综述中，我们选择了过去8年发表的研究，这些研究分析了接受手术的HCC-NAFLD患者的特征和结局，目的是确定可以预测结局的特征和潜在的选择标准。所有研究均证实，HCC-NAFLD患者年龄较大，合并症较多，并且即使在非肝硬化肝脏中HCC也经常发生。关于术中及围手术期并发症尚无共识。关于结局，所有论文均一致认为，接受手术的NAFLD相关HCC患者的OS优于其他病因导致的患者。总之，手术对于HCC-NAFLD患者是一种很好的根治性选择，就OS而言可能甚至优于移植。在这组患者中，除了与肝功能相关的正常风险评估外，评估心肺和一般手术风险似乎至关重要，以避免低估风险，尤其是对于没有严重潜在纤维化的患者。
