Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease.
Hepatocellular carcinoma surveillance in patients with non-alcoholic fatty liver disease.
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非酒精性脂肪性肝病患者的肝细胞癌监测。
DOI：
10.3350/cmh.2022.0247
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发表时间：
2023-02
影响因子：
8.9
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
--
作者：
El Dahan, Karim Seif;Daher, Darine;Singal, Amit G.
关键词：
非酒精性脂肪性肝病(NAFLD)可进展为肝硬化性或非肝硬化性肝细胞癌(HCC)，目前被认为是全球范围内肝细胞癌增长最快的原因。因此，专业学会指南建议对任何病因的肝硬变患者进行肝细胞癌监测，一些人可能认为对非肝硬化性非酒精性脂肪肝患者进行肝细胞癌风险较高的亚组是有益的。值得注意的是，与NAFLD相关的肝细胞癌患者更有可能在更晚期被诊断为肝细胞癌，与其他病因相比，预后更差，而肝细胞癌监测计划的次优效果是主要罪魁祸首。在这篇综述中，我们总结了目前的肝细胞癌监测指南，并讨论了其对非酒精性脂肪肝患者的益处和潜在危害。我们还讨论了NAFLD中肝细胞癌监测的独特挑战，包括NAFLD相关性无肝硬变的肝细胞癌比例较高，对高危患者的认识不足，对非肝硬化性NAFLD监测的价值缺乏共识，与NAFLD表型相关的监测工具的有效性不佳，以及NAFLD患者普遍监测不足。最后，我们检查了当前使用的监测工具(即超声和甲胎蛋白)的有效性，并概述了未来的前景，包括新兴的风险分层工具、成像监测战略(例如，简化的磁共振成像方案)、基于血液的生物标记物(例如，Galad和循环肿瘤DNA面板)，以及提高监测依从性的干预措施。
Non-alcoholic fatty liver disease (NAFLD) may progress to cirrhotic or non-cirrhotic hepatocellular carcinoma (HCC), and is currently recognized as the fastest growing cause of HCC worldwide. Accordingly, professional society guidelines recommend HCC surveillance in patients with cirrhosis from any etiology, and some may consider it beneficial in subgroups with non-cirrhotic NAFLD at higher risk for HCC. Notably, patients with NAFLD-related HCC are more likely to have HCC diagnosed at more advanced stages and have poorer outcomes when compared to other etiologies, and suboptimal effectiveness of HCC surveillance programs is a major culprit. In this review, we summarize the current guidelines for HCC surveillance and discuss its benefits versus potential harms for NAFLD patients. We also address the unique challenges of HCC surveillance in NAFLD, including higher proportion of NAFLD-related HCC without cirrhosis, poor recognition of at-risk patients, lack of consensus regarding the value of surveillance in non-cirrhotic NAFLD, subpar effectiveness of surveillance tools related to NAFLD phenotype, and preponderant surveillance underuse among NAFLD patients. Finally, we examine the effectiveness of currently used surveillance tools (i.e., ultrasound and alpha fetoprotein) and outline future perspectives including emerging risk stratification tools, imaging surveillance strategies (e.g., abbreviated magnetic resonance imaging protocols), blood-based biomarkers (e.g., GALAD and circulating tumor DNA panels), and interventions to improve surveillance adherence.
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影响因子：
29.4
作者：
Kanwal F;Kramer JR;Mapakshi S;Natarajan Y;Chayanupatkul M;Richardson PA;Li L;Desiderio R;Thrift AP;Asch SM;Chu J;El-Serag HB
通讯作者：
El-Serag HB
影响因子：
12.6
作者：
Best, Jan;Bechmann, Lars P.;Canbay, Ali
通讯作者：
Canbay, Ali
影响因子：
25.7
作者：
Dyson, Jessica;Jaques, Bryan;Reeves, Helen L.
通讯作者：
Reeves, Helen L.
影响因子：
12.6
作者：
Berhane, Sarah;Toyoda, Hidenori;Johnson, Philip
通讯作者：
Johnson, Philip
DOI：
10.1016/j.cgh.2008.08.005
发表时间：
2008-12
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Andersson KL;Salomon JA;Goldie SJ;Chung RT
通讯作者：
Chung RT