Editor’s Pick: Non-Alcoholic Fatty Liver Disease – Changing the Prevalence of Liver Cancer?

With the introduction of effective curative treatment for hepatitis C, the incidence of the  hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) will be gradually declining within the next 20 years, at least in Western countries which will have wider access to these drugs within the next few years. Since chronic hepatitis B is also fairly well controlled in patients with known infection, alcoholic and non-alcoholic fatty liver disease are the two remaining big aetiologies of chronic liver disease in need of better treatments. Amongst the two, it is non-alcoholic fatty liver disease (NAFLD) that has shown the biggest increase in prevalence  globally, mostly in developed countries but also increasingly in developing countries. Despite the fact that severe liver damage occurs only in a small fraction of patients with NAFLD, the proinflammatory environment constitutes an important precancerous condition, making liver cancer the most important obesity-related malignancy, particularly in men. Understanding this means putting a major effort into preventing NAFLD, into identifying what drives the inflammation in the liver, and ultimately into finding a cure for it. Prof Dr  Markus Peck-Radosavljevic

Benedetta Campana,1,2 David Semela,3 Markus Heim,1,2  *Christine Bernsmeier1,3,4

1. Department of Biomedicine, University of Basel, Basel, Switzerland
2. Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
3. Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
4. Institute of Liver Sciences, King’s College London, London, UK
*Correspondence to c.bernsmeier@unibas.ch

Disclosure: No potential conflict of interest.
Received: 31.10.14 Accepted: 03.12.14
Citation: EMJ Hepatol. 2015;3[1]:12-18.

Abstract

Due to its increasing prevalence, exceeding 25% of the Western population, non-alcoholic fatty liver disease (NAFLD) merits recognition as one of the most frequent chronic liver diseases (CLD) and requires consideration of the associated disease-related complications and their consequences for the surveillance and treatment of patients and the socio-economy worldwide. Along with the increasing incidence of  NAFLD-related cirrhosis and end-stage liver disease, the frequency of NAFLD-related hepatocellular carcinoma (HCC) is rising and expected to surpass HCC related to chronic hepatitis C in the upcoming future. These epidemiologic changes will impact on the overall mortality of CLD and the requirement of organs for transplantation. Although the risk of HCC in NAFLD, similar to other CLD, is related to fibrosis (advanced fibrosis increases the risk of HCC 25-fold), there are reports suggesting a considerable rate of HCC also developing in simple hepatic steatosis. Moreover, HCC is nowadays the leading cause of  obesity-related cancer mortality; cancers of other origin such as colorectal cancer are more prevalent in patients with NAFLD and obesity. The pathophysiology of HCC has mainly been studied in models of viral hepatitis. Given the expected raise in NAFLD-related HCC, a better understanding of the pathophysiology of carcinogenesis in NAFLD and obesity is desired in order to better define chemopreventive strategies. Here we review the epidemiology, aetiology, and pathogenesis of HCC on the background of NAFLD  and deduce potential consequences for the management of patients in respect to the NAFLD epidemic.

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