Korean J Gastroenterol.  2017 Jun;69(6):348-352. 10.4166/kjg.2017.69.6.348.

The Development of Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease

• Kwon OS
• Kim JH
• Kim JH

• KMID: 2384361
• DOI: http://doi.org/10.4166/kjg.2017.69.6.348

Abstract

Non-alcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). NAFLD-related HCCs (NAFLD-HCCs) have the following clinical features: high body mass index, deranged lipid profiles, diabetes mellitus, hypertension, and metabolic syndrome. Among them, obesity, diabetes mellitus, and high Fe contents in the liver are risk factors of developing HCC in patients with NAFLD. Inflammatory cytokines, adipokines, insulin like growth factor-I, and lipotoxicity are intermingled and may cross react with each other to develop HCC. Because there is no guideline for early detection of HCC in patients with NAFLD, NAFLD-HCCs tend to be greater in size and in advanced stages when detected compared with hepatitis virus-related HCCs. Therefore, there is an urgent need of a surveillance program for the early detection of HCC. Treatment of NAFLD-HCCs is not different from other causes-related HCCs. However, patients with NAFLD-HCCs have cardiovascular disease and other metabolic problems, which may complicate treatment.

Keyword

Hepatocellular carcinoma; Non-alcoholic fatty liver disease

MeSH Terms

Adipokines
Body Mass Index
Carcinoma, Hepatocellular*
Cardiovascular Diseases
Cytokines
Diabetes Mellitus
Hepatitis
Humans
Hypertension
Insulin
Liver
Non-alcoholic Fatty Liver Disease*
Obesity
Risk Factors
Adipokines
Cytokines
Insulin

Figure

• 

  Fig. 1. Natural course of NAFLD. HCC can develop not only from cirrhotic liver, but also from non-cirrhotic liver. The prevalence of HCC without cirrhosis in NAFLD-related HCC was 34–48%. NAFLD, non-alcoholic fatty liver disease; HCC, hepatocellular carcinoma; NASH, non-alcoholic steatohepatitis; LC, liver cirrhosis; NAFLD- HCC, NAFLD related HCC.

• 

  Fig. 2. Mechanism of HCC development in NAFLD. HCC, hepatocellular carcinoma; NAFLD, non-alcoholic fatty liver disease; DM, diabetes mellitus; IGF-1, insulin-like growth factor 1.

Reference

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