| Theme |
NASH -- Pathogenesis and Treatment |
| Title |
Hepatocellular Carcinoma Due to Nonalcoholic Steatohepatitis |
| Author |
Makiko Taniai |
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Womenʼs Medical University |
| Author |
Etsuko Hashimoto |
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Womenʼs Medical University |
| [ Summary ] |
The incidence of hepatocellular carcinoma (HCC) in nonviral-related chronic liver disease has increased in Japan. This increase is influenced by the drastic increase in the prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population in Japan. Obesity and type 2 diabetes mellitus (DM) have been established as a significant risk factors for HCC through many clinical and experimental studies. These risk factors for HCC consist of two factors : the increased risk for development of non-alcoholic steatohepatitis (NASH) and the carcinogenic potential of themselves. HCC is difficult to evaluate in NASH patients because histological diagnosis is required for diagnosis of NASH. This may lead to a selection bias. Furthermore, end-stage NASH is in effect "burned-out" NASH, for which a diagnosis of NASH can no longer be considered. Previous studies on the etiology of Japanese HCC shown that NAFLD accounts for 1-5 % of all HCC cases (male predominant, median age over 70 years). These patients exhibit a high prevalence of obesity and/or type 2 DM and 10-75 % of the HCC arise from non-cirrhotic livers. HCC in NASH may be of multicentric origin, similar to HCC due to viral hepatitis. Regular screening for HCC is extremely important especially in cirrhotic NASH patients and recurrence should be watched for. |