Epidemiology and risk-stratification of NAFLD-associated HCC
Epidemiology and risk-stratification of NAFLD-associated HCC
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DOI：
10.1016/j.jhep.2021.08.012
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发表时间：
2021-11-15
影响因子：
25.7
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
--
作者：
Ioannou, George N.
非酒精性脂肪性肝病（NAFLD）预计将成为许多国家肝细胞癌（HCC）的主要原因。NAFLD的许多危险因素也与HCC独立相关，包括肥胖、糖尿病、西班牙裔种族和PNPLA 3、TM 6SF 2、GCKR、MBOAT 7和HSD 17 B13的遗传多态性。脂肪变性相关的脂毒性和DNA氧化损伤可诱导肝癌的发生。这些因素可以解释NAFLD和HCC之间的关联，特别是在没有肝硬化的情况下。事实上，在没有肝硬化的情况下，NAFLD/NASH是HCC的主要原因。识别具有足够高的HCC风险以证明HCC筛查的NAFLD患者是NAFLD中最大的临床挑战之一。将联合收割机多种危险因素和纤维化分期结合成“HCC风险计算器”的有效模型尚未用于NAFLD患者。此类工具的开发将实现风险分层、即使在没有肝硬化的情况下也能识别高风险患者以及个性化（基于风险的）监测策略。由Elsevier B. V.代表欧洲肝脏研究协会出版。
Non-alcoholic fatty liver disease (NAFLD) is projected to become the leading cause of hepatocellular carcinoma (HCC) in many countries. Many risk factors for NAFLD are also independently associated with HCC, including obesity, diabetes, Hispanic ethnicity and genetic polymorphisms in PNPLA3, TM6SF2, GCKR, MBOAT7 and HSD17B13. Steatosis-related lipotoxicity and oxidative DNA damage can induce hepatocarcinogenesis. These factors may explain the association between NAFLD and HCC, especially in the absence of cirrhosis. In fact, NAFLD/NASH is a leading cause of HCC in the absence of cirrhosis. Identifying patients with pre-cirrhotic NAFLD who have a high enough HCC risk to justify HCC screening represents one of the greatest clinical challenges in NAFLD. Validated models that combine multiple risk factors and fibrosis stage into "HCC risk calculators" are not yet available for patients with NAFLD. Development of such tools would enable risk stratification, identification of high-risk patients even in the absence of cirrhosis, and individualised (risk-based) surveillance strategies. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.