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

Oh Sang Kwon; Joon Hwan Kim; Ju Hyun Kim

doi:10.4166/kjg.2017.69.6.348

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Kwon, Kim, and Kim: The Development of Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease

Review Article

Korean J Gastroenterol 2017;69(6):348-352.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.6.348

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

Oh Sang Kwon, Joon Hwan Kim, Ju Hyun Kim

Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to: Ju Hyun Kim, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-3778, Fax: +82-32-460-3408, E-mail: jhkim@gilhospital.com

Received 17 April 2017 Revised 4 May 2017 Accepted 8 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 inter-mingled 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.

Keywords: Hepatocellular carcinoma, Non-alcoholic fatty liver disease

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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.

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