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Nevola et al. Hepatoma Res 2018;4:55 Hepatoma Research
DOI: 10.20517/2394-5079.2018.38

Review Open Access

Mechanisms and clinical behavior of hepatocellular
carcinoma in HBV and HCV infection and alcoholic
and non-alcoholic fatty liver disease

Riccardo Nevola, Luca Rinaldi, Mauro Giordano, Aldo Marrone, Luigi Elio Adinolfi

Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, University of Campania “L. Vanvitelli”, Division of
Internal Medicine, Piazza Miraglia, Naples 80138, Italy.
Correspondence to: Prof. Luigi Elio Adinolfi, Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, University
of Campania “L. Vanvitelli”, Division of Internal Medicine, Piazza Miraglia, Naples 80138, Italy. E-mail: luigielio.adinolfi@unicampania.it
How to cite this article: Nevola R, Rinaldi L, Giordano M, Marrone A, Adinolfi LE. Mechanisms and clinical behavior of hepatocellular
carcinoma in HBV and HCV infection and alcoholic and non-alcoholic fatty liver disease. Hepatoma Res 2018;4:55.
http://dx.doi.org/10.20517/2394-5079.2018.38

Received: 10 Apr 2018 First Decision: 8 Jul 2018 Revised: 15 Jul 2018 Accepted: 16 Jul 2018 Published: 20 Sep 2018
Science Editor: Guang-Wen Cao Copy Editor: Huan-Liang Wu Production Editor: Zhong-Yu Guo

Abstract
Hepatocellular carcinoma (HCC) is the main tumor of the liver and is the sixth most frequently diagnosed tumor
in the world. It is the evolution of chronic hepatic injury secondary to different etiologies. Chronic hepatitis B virus
and hepatitis C virus infection, chronic alcoholic hepatitis, as well as non-alcoholic fatty liver disease are the most
common causes behind the development of HCC. The introduction of effective prophylaxis and treatment against
hepatitis B, the recent use of highly effective hepatitis C treatments, as well as lifestyle changes observed in recent
decades in the general population causing an increase in obesity and metabolic syndrome have led to significant
epidemiological change in HCC in relation to the changed etiologic prevalence of liver injury. Increasing evidence
was emerging, emphasizing how the development of HCC is a complex and multifactorial process. The knowledge
of the molecular mechanisms involved is important for the understanding of the basic factors of the development
of hepatocarcinogenesis and of possible therapeutic approaches. Several pathogenic mechanisms and clinical
expression of HCC occur in relation to the different etiologies of the underlying liver disease. The different clinical
behavior of HCC often makes diagnosis difficult at an early stage, that is necessary for an effective therapeutic
approach. This review analyzes the possible different pathogenic mechanisms involved in the development of HCC
and emphasizes the different epidemiological and clinical aspects of HCC observed in the most common forms of
liver diseases of viral and non-viral origin.

Keywords: Hepatocellular carcinoma, hepatitis C virus, hepatitis B virus, alcohol hepatitis, non-alcoholic fatty liver
disease

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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