AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review.
AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review.
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DOI：
10.1053/j.gastro.2019.12.053
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发表时间：
2020-05
期刊：
影响因子：
29.4
通讯作者：
El-Serag HB
中科院分区：
文献类型：
--
作者：
Loomba R;Lim JK;Patton H;El-Serag HB
非酒精性脂肪性肝病（NAFLD）是慢性肝病的主要病因，具有巨大的公共卫生影响，影响超过25%的美国和全球人口。高达1/4的NAFLD患者可能患有非酒精性脂肪性肝炎（NASH）。NASH与由于肝硬化、肝失代偿和肝细胞癌（HCC）的并发症引起的显著发病率和死亡率相关。最近的数据证实，HCC是第五大常见癌症，是全球癌症相关死亡的第二大原因，NAFLD已被确定为这种恶性肿瘤的快速新兴风险因素。NAFLD相关的肝脏并发症预计将成为未来十年肝移植的主要指征。尽管有证据表明NAFLD相关的HCC可能在没有肝硬化的情况下出现，通常在晚期被诊断，并且与接受治疗性治疗的较少和生存率较差相关，但目前的社会指南提供了有限的指导/建议，以解决在已建立的肝硬化背景之外的NAFLD患者中的HCC监测。目前有限的数据可用于指导临床医生关于NAFLD患者应接受HCC监测，最佳筛查工具，监测频率以及共存的宿主和疾病相关风险因素的影响。在此，我们提出了一个基于证据的审查，解决与NAFLD患者的肝癌风险，并提供最佳实践建议声明，以解决临床管理中的关键问题。
Nonalcoholic fatty liver disease (NAFLD) is a leading etiology for chronic liver disease with an immense public health impact and affects >25% of the US and global population. Up to 1 in 4 NAFLD patients may have nonalcoholic steatohepatitis (NASH). NASH is associated with significant morbidity and mortality due to complications of liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Recent data confirm that HCC represents the fifth most common cancer and is the second leading cause of cancer-related death worldwide, and NAFLD has been identified as a rapidly emerging risk factor for this malignancy. NAFLD-associated liver complications are projected to become the leading indication for liver transplantation in the next decade. Despite evidence that NAFLD-associated HCC may arise in the absence of cirrhosis, is often diagnosed at advanced stages, and is associated with lower receipt of curative therapy and with poorer survival, current society guidelines provide limited guidance/recommendations addressing HCC surveillance in patients with NAFLD outside the context of established cirrhosis. Limited data are presently available to guide clinicians with respect to which patients with NAFLD should undergo HCC surveillance, optimal screening tools, frequency of monitoring, and the influence of coexisting host- and disease-related risk factors. Herein we present an evidence-based review addressing HCC risk in patients with NAFLD and provide Best Practice Advice statements to address key issues in clinical management.
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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：
25.7
作者：
Dulai PS;Sirlin CB;Loomba R
通讯作者：
Loomba R
影响因子：
6.7
作者：
Kolly, Philippe;Knopfli, Marina;Dufour, Jean-Francois
通讯作者：
Dufour, Jean-Francois
DOI：
10.1136/bmj.c1240
发表时间：
2010-03-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Hart CL;Morrison DS;Batty GD;Mitchell RJ;Davey Smith G
通讯作者：
Davey Smith G
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