NAFLD-Related Hepatocarcinoma: The Malignant Side of Metabolic Syndrome.
Anna MichelottiMarco de ScordilliLorenza PalmeroMichela GuardascioneMario MasalaRossana RoncatoLuisa FoltranElena OngaroFabio PuglisiPublished in: Cells (2021)
Hepatocellular carcinoma (HCC) is the seventh most common cancer worldwide and the second leading cause of cancer-related mortality. HCC typically arises within a cirrhotic liver, but in about 20% of cases occurs in absence of cirrhosis. Among non-cirrhotic risk factors, non-alcoholic fatty liver disease (NAFLD) currently represents the most important emerging cause of HCC in developed countries. It has been estimated that annual incidence of HCC among patients with non-cirrhotic NAFLD is approximately 0.1-1.3 per 1000 patients/year and ranges from 0.5% to 2.6% among patients with non-alcoholic steatohepatitis (NASH) cirrhosis. However, only a few clinical trials enrolling HCC patients actually distinguished NAFLD/NASH-related cases from other non-cirrhotic causes and therefore evidence is still lacking in this subset of patients. This review aims to describe the biology underpinning NAFLD development, to investigate the main molecular pathways involved in its progression to NASH and HCC and to describe how different pathogenetic mechanisms underlying the onset of HCC can have an impact in clinical practice. We hereby also provide an overview of current HCC treatment options, with a particular focus on the available data on NAFLD-related cases in practice-changing clinical trials.
Keyphrases
- end stage renal disease
- clinical trial
- risk factors
- metabolic syndrome
- ejection fraction
- newly diagnosed
- chronic kidney disease
- peritoneal dialysis
- prognostic factors
- primary care
- type diabetes
- squamous cell carcinoma
- randomized controlled trial
- clinical practice
- machine learning
- patient reported outcomes
- deep learning
- papillary thyroid
- big data
- young adults
- study protocol
- open label
- patient reported