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Bellentani. Hepatoma Res 2020;6:29 Hepatoma Research
DOI: 10.20517/2394-5079.2020.10

Review Open Access

Epidemiology of hepatocellular carcinoma in
metabolic liver disease

Stefano Bellentani

Consultant Gastroenterologist and Hepatologist 6600 Locarno, Ticino, Switzerland.
Correspondence to: Dr. Stefano Bellentani, Studio Medico - Via Della Pace 3, 6600 Locarno, Ticino, Switzerland.
E-mail: bellentanistefano@gmail.com

How to cite this article: Bellentani S. Epidemiology of hepatocellular carcinoma in metabolic liver disease. Hepatoma Res
2020;6:29. http://dx.doi.org/10.20517/2394-5079.2020.10

Received: 3 Feb 2020 First Decision: 10 Apr 2020 Revised: 16 Apr 2020 Accepted: 20 Apr 2020 Published: 16 Jun 2020

Science Editor: Darrell Crawford Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
Nonalcoholic fatty liver disease and its evolutive form nonalcoholic steatohepatitis (NASH) are nowadays the
Received: First Decision: Revised: Accepted: Published: second/third cause of chronic liver disease worldwide, and their prevalence and incidence are rapidly increasing
in parallel to the burden of diabetes and obesity. Hepatocellular carcinoma (HCC) due to NASH (HCC-NASH) has
Science Editor: Copy Editor: Production Editor: Jing Yu become the major cause of HCC and is now one of the major indications for liver transplant in Western countries,
after that due to HCV infection. NASH occurs both in the presence and absence of liver cirrhosis. In this review, we
describe the epidemiology of HCC related to metabolic liver disease: not only NASH-HCC but also type 2 diabetes
mellitus and obesity-related HCC. Some new practical guidelines for screening and surveillance of patients with
metabolic diseases at risk for HCC are also discussed.

Keywords: Nonalcoholic steatohepatitis, hepatocellular carcinoma, metabolic syndrome, obesity, type 2 diabetes
mellitus

INTRODUCTION
The prevalence of nonalcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC) is
increasing in parallel with the prevalence of nonalcoholic fatty liver disease (NAFLD), type 2 diabetes
[1]
mellitus (T2DM) and obesity worldwide, particularly in Western countries . HCC develops in patients
[2,3]
with NASH and without cirrhosis in 40% of cases . In patients with NASH and advanced (F3) fibrosis
or Child A cirrhosis, approximately 20% of patients progress to decompensated cirrhosis over a 2-year

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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