Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Nat Rev Gastroenterol Hepatol. 2021 Apr;18(4):223-238. doi: 10.1038/s41575-020-00381-6. Epub 2020 Dec 21.
One quarter of the global population is estimated to have nonalcoholic fatty liver disease (NAFLD). The incidence of nonalcoholic steatohepatitis (NASH) is projected to increase by up to 56% in the next 10 years. NAFLD is already the fastest growing cause of hepatocellular carcinoma (HCC) in the USA, France and the UK. Globally, the prevalence of NAFLD-related HCC is likely to increase concomitantly with the growing obesity epidemic. The estimated annual incidence of HCC ranges from 0.5% to 2.6% among patients with NASH cirrhosis. The incidence of HCC among patients with non-cirrhotic NAFLD is lower, approximately 0.1 to 1.3 per 1,000 patient-years. Although the incidence of NAFLD-related HCC is lower than that of HCC of other aetiologies such as hepatitis C, more people have NAFLD than other liver diseases. Urgent measures that increase global awareness and tackle the metabolic risk factors are necessary to reduce the impending burden of NAFLD-related HCC. Emerging evidence indicates that reduced immune surveillance, increased gut inflammation and gut dysbiosis are potential key steps in tumorigenesis. In this Review, we discuss the global epidemiology, projections and risk factors for NAFLD-related HCC, and propose preventive strategies to tackle this growing problem.
据估计，全球四分之一的人口患有非酒精性脂肪性肝病（NAFLD）。预计在未来 10 年内，非酒精性脂肪性肝炎（NASH）的发病率将增加高达 56%。NAFLD 已经成为美国、法国和英国肝细胞癌（HCC）增长最快的病因。在全球范围内，随着肥胖症的流行，NAFLD 相关 HCC 的患病率可能会相应增加。在 NASH 肝硬化患者中，HCC 的估计年发病率在 0.5%至 2.6%之间。在非肝硬化性 NAFLD 患者中，HCC 的发病率较低，约为每 1000 患者年 0.1 至 1.3 例。尽管 NAFLD 相关 HCC 的发病率低于丙型肝炎等其他病因引起的 HCC，但患有 NAFLD 的人比其他肝病患者多。必须采取增加全球认识和解决代谢危险因素的紧急措施，以减轻即将出现的 NAFLD 相关 HCC 的负担。新出现的证据表明，免疫监视减弱、肠道炎症和肠道菌群失调增加是肿瘤发生的潜在关键步骤。在这篇综述中，我们讨论了 NAFLD 相关 HCC 的全球流行病学、预测和危险因素，并提出了应对这一日益严重问题的预防策略。
