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HCC in NFALD: temporal trends
With better HCV treatment it is clear that HCV-induced HCC will decline in the coming years. Roughly
8% of HCC patients have NAFLD as an underlying risk factor [11], but there is significant geographical
variation in this proportion. Temporal trends also exist. HCC associated with NAFLD accounted for
35% of cases in an English referral liver unit in 2010, representing a >10 fold increase from 2000 [17].
The number of patients undergoing LT for HCC secondary to NASH increased by nearly four-fold
from 2002 to 2012 (United Network for Organ Sharing registry), more than any other indication for
liver transplantation in patients with HCC [18].
References (*required reading)
[1] Yatsuji S, Hashimoto E, Tobari M, et al. Clinical features and outcomes of cirrhosis due to non-
alcoholic steatohepatitis compared with cirrhosis caused by chronic hepatitis C. J Gastroenterol
Hepatol 2009;24:248-254.
[2] Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to
nonalcoholic steatohepatitis and hepatitis C. Hepatology 2006;43:682-689.
[3] Bugianesi E, Leone N,Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis:
from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002;123:134-140.
[4] Regimbeau JM, Colombat M, Mognol P, et al. Obesity and diabetes as a risk factor for hepatocellular
carcinoma. Liver Transpl 2004;10:S69-73.
[5] Ratziu V, Bonyhay L, Di Martino V, et al. Survival, liver failure, and hepatocellular carcinoma in
obesity-related cryptogenic cirrhosis. Hepatology 2002;35:1485-1493.
[6] Calle EE, Teras LR, Thun MJ. Adiposity and physical activity as predictors of mortality. N Engl J
Med 2005;352:1381-1384; author reply 1381-1384.
[7] El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology
2004;127:S27-34.
[8] Paradis V, Zalinski S, Chelbi E, et al. Hepatocellular carcinomas in patients with metabolic
syndrome often develop without significant liver fibrosis: a pathological analysis. Hepatology
2009;49:851-859. *
[9] Yasui K, Hashimoto E, Komorizono Y, et al. Characteristics of patients with nonalcoholic
steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol 2011;9:428-
433; quiz e450. *
[10] Tateishi R, Okanoue T, Fujiwara N, et al. Clinical characteristics, treatment, and prognosis
of non-B, non-C hepatocellular carcinoma: a large retrospective multicenter cohort study. J
Gastroenterol 2014.
[11] Mittal S, Sada YH, El-Serag HB, et al. Temporal Trends of Nonalcoholic Fatty Liver Disease-
Related Hepatocellular Carcinoma in the Veteran Affairs Population. Clin Gastroenterol Hepatol
2014; doi: 10.1016/j.cgh.2014.08.013.
[12] Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology
2011;53:1020-1022.
[13] Hashimoto E, Yatsuji S, Tobari M, et al. Hepatocellular carcinoma in patients with nonalcoholic
steatohepatitis. J Gastroenterol 2009;44 Suppl 19:89-95.
[14] Liu YL, Patman GL, Leathart JB, et al. Carriage of the PNPLA3 rs738409 C >G polymorphism
confers an increased risk of non-alcoholic fatty liver disease associated hepatocellular carcinoma.
J Hepatol 2014;61:75-81.
[15] European Association for the Study of the Liver, European Organisation for Research and
Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular
carcinoma. J Hepatol 2012;56:908-943. *
[16] Zhang ZJ, Zheng ZJ, Shi R, et al. Metformin for liver cancer prevention in patients with type 2
diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012;97:2347-2353.
[17] Dyson J, Jaques B, Chattopadyhay D, et al. Hepatocellular cancer: the impact of obesity, type 2
diabetes and a multidisciplinary team. J Hepatol 2014;60:110-117.
[18] Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication
for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology
2014;59:2188-2195.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 83
With better HCV treatment it is clear that HCV-induced HCC will decline in the coming years. Roughly
8% of HCC patients have NAFLD as an underlying risk factor [11], but there is significant geographical
variation in this proportion. Temporal trends also exist. HCC associated with NAFLD accounted for
35% of cases in an English referral liver unit in 2010, representing a >10 fold increase from 2000 [17].
The number of patients undergoing LT for HCC secondary to NASH increased by nearly four-fold
from 2002 to 2012 (United Network for Organ Sharing registry), more than any other indication for
liver transplantation in patients with HCC [18].
References (*required reading)
[1] Yatsuji S, Hashimoto E, Tobari M, et al. Clinical features and outcomes of cirrhosis due to non-
alcoholic steatohepatitis compared with cirrhosis caused by chronic hepatitis C. J Gastroenterol
Hepatol 2009;24:248-254.
[2] Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to
nonalcoholic steatohepatitis and hepatitis C. Hepatology 2006;43:682-689.
[3] Bugianesi E, Leone N,Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis:
from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002;123:134-140.
[4] Regimbeau JM, Colombat M, Mognol P, et al. Obesity and diabetes as a risk factor for hepatocellular
carcinoma. Liver Transpl 2004;10:S69-73.
[5] Ratziu V, Bonyhay L, Di Martino V, et al. Survival, liver failure, and hepatocellular carcinoma in
obesity-related cryptogenic cirrhosis. Hepatology 2002;35:1485-1493.
[6] Calle EE, Teras LR, Thun MJ. Adiposity and physical activity as predictors of mortality. N Engl J
Med 2005;352:1381-1384; author reply 1381-1384.
[7] El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology
2004;127:S27-34.
[8] Paradis V, Zalinski S, Chelbi E, et al. Hepatocellular carcinomas in patients with metabolic
syndrome often develop without significant liver fibrosis: a pathological analysis. Hepatology
2009;49:851-859. *
[9] Yasui K, Hashimoto E, Komorizono Y, et al. Characteristics of patients with nonalcoholic
steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol 2011;9:428-
433; quiz e450. *
[10] Tateishi R, Okanoue T, Fujiwara N, et al. Clinical characteristics, treatment, and prognosis
of non-B, non-C hepatocellular carcinoma: a large retrospective multicenter cohort study. J
Gastroenterol 2014.
[11] Mittal S, Sada YH, El-Serag HB, et al. Temporal Trends of Nonalcoholic Fatty Liver Disease-
Related Hepatocellular Carcinoma in the Veteran Affairs Population. Clin Gastroenterol Hepatol
2014; doi: 10.1016/j.cgh.2014.08.013.
[12] Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology
2011;53:1020-1022.
[13] Hashimoto E, Yatsuji S, Tobari M, et al. Hepatocellular carcinoma in patients with nonalcoholic
steatohepatitis. J Gastroenterol 2009;44 Suppl 19:89-95.
[14] Liu YL, Patman GL, Leathart JB, et al. Carriage of the PNPLA3 rs738409 C >G polymorphism
confers an increased risk of non-alcoholic fatty liver disease associated hepatocellular carcinoma.
J Hepatol 2014;61:75-81.
[15] European Association for the Study of the Liver, European Organisation for Research and
Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular
carcinoma. J Hepatol 2012;56:908-943. *
[16] Zhang ZJ, Zheng ZJ, Shi R, et al. Metformin for liver cancer prevention in patients with type 2
diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012;97:2347-2353.
[17] Dyson J, Jaques B, Chattopadyhay D, et al. Hepatocellular cancer: the impact of obesity, type 2
diabetes and a multidisciplinary team. J Hepatol 2014;60:110-117.
[18] Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication
for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology
2014;59:2188-2195.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 83
