Should patients with NAFLD/NASH Be surveyed for HCC?
Open accessAbstract
BACKGROUND: Patients with nonalcoholic fatty liver disease (NAFLD) are at risk of developing hepatocellular carcinoma (HCC), but the magnitude of the association still needs to be determined to define the need for a specific surveillance strategy. METHODS: We based our assessment on a previously published review by White et al (1992-2011) and on a systematic review(2012-2017). RESULTS: The new search identified 328 abstracts. Combining both eras (1992-2011 and 2012-2017), 25 studies were included in the analysis. Four were prospective, 2 described a retrospective analysis of a prospective database, and the others were retrospective. All studies were published after 2004, but the inclusion period of half of them ended before the year 2000. Studies showed variation in the definition of NAFLD, in the incidence of fibrosis/cirrhosis, in the presence of comorbidities (potentially affecting HCC incidence), and in the type and duration of screening. Considering only studies strictly including patients with or without cirrhosis, the reported incidence of HCC in NAFLD patients with cirrhosis was between 6.7 and 15% at 5 to 10 years, whereas the incidence in NAFLD patients without cirrhosis was 2.7% at 10 years and 23 per 100 000 person-years. CONCLUSIONS: Hepatocellular carcinoma screening in NAFLD patients with cirrhosis is mandatory. However, the currently observed low (and insufficiently documented) incidence of HCC in NAFLD patients without cirrhosis does not justify a systematic surveillance. Research efforts should focus on developing a score, which could aid the clinician in identifying NAFLD patients without cirrhosis who are at higher risk of developing HCC.
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A recent study found a low incidence of HCC at 10 years (2.7%) in those with MASLD without cirrhosis.
“A recent study updated these fi gures and found a low incidence of HCC at 10 years (2.7%) in those with MASLD without cirrhosis. 242”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [242]
The HCC incidence in individuals without cirrhosis is very low, ranging from 0.08 to 0.63 per 1,000 person-years.
“the HCC incidence in individuals without cirrhosis is very low, ranging from 0.08 to 0.63 per 1,000 PY. 240 -244”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [242]
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- Authors
- Reig, M., Gambato, M., Man, N. K., Roberts, J. P., Victor, D., Orci, L. A., & Toso, C.
- Affiliations
- Barcelona Clinic Liver Cancer (BCLC) Group, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
- Azienda Ospedale - Università Padova (IT)
- University of Hong Kong (HK)
- University of California, San Francisco (US)
- Houston Methodist (US)
- University Hospital of Geneva (CH)
- Corresponding author
- Toso, Christian
- Venue
- Transplantation
- Published
- 2019-01
- Volume
- 103
- Issue
- 1
- Pages
- 39-44
- ISSN
- 0041-1337 (ISSN-L)
- 1534-6080
- OpenAlex
- W2887965899
- Cited by
- 71
- References
- 39
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 7 · 2023: 11 · 2022: 6 · 2021: 14 · 2020: 14 · 2019: 9 · 2018: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, hepatocellular carcinoma, HCC incidence, liver cirrhosis, HCC surveillance, HCC screening, risk stratification, comorbidities
- MeSH terms
- Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Risk Factors, Comorbidity, Incidence, Practice Guidelines as Topic, Disease Progression, Early Detection of Cancer, Non-alcoholic Fatty Liver Disease
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