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Best et al. Hepatoma Res 2021;7:32 Hepatoma Research
DOI: 10.20517/2394-5079.2021.52

Editorial Open Access

The narrow ridge from liver damage to

hepatocarcinogenesis

1
Jan Best , Guido Gerken 2
1
Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum
44892, Germany.
2
Department of Gastroenterology and Hepatology, University Hospital Essen, Essen 45147, Germany.
Correspondence to: Dr. Jan Best, MD, Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum,
In der Schornau 23-25, Bochum 44892, Germany. E-mail: jan.best@kk-bochum.de

How to cite this article: Best J, Gerken G. The narrow ridge from liver damage to hepatocarcinogenesis. Hepatoma Res 2021;7:32.
https://dx.doi.org/10.20517/2394-5079.2021.52

Received: 13 Apr 2021 Accepted: 14 Apr 2021 Published: 17 Apr 2021

Academic Editor: Guang-Wen Cao Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Globally, hepatocellular carcinoma (HCC) is associated with a poor prognosis due to frequent diagnosis in
late stages. As a result, mortality is roughly equivalent to the annual incidence. Regardless of etiology, the
development of liver cirrhosis is the most relevant cause of hepatocarcinogenesis . Chronic hepatitis B
[1]
virus (HBV) infection and nonalcoholic steatohepatitis (NASH) are associated with a significantly increased
risk of developing HCC even in the absence of cirrhosis . Recent data demonstrate that NASH has to be
[2]
considered as the main cause of the increasing incidence of HCC predicted for the next decades . Thus,
[3]
against the background of high mortality, the need for optimized HCC screening strategies arises on the one
hand, while, on the other hand, previous treatment concepts have to be adapted to the sometimes therapy-
limiting comorbidities of these patients.

The global prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be 25%, although this
[4]
figure may still be underestimated due to an assumed high number of unreported cases . In approximately
10%-15% of NAFLD patients, progression to NASH can occur, which in turn can lead to higher-grade
fibrosis and, in the final stage, to cirrhosis and HCC . Approximately 20% of all NASH-associated HCC
[5]
cases develop in the absence of overt cirrhosis . According to the most recent epidemiological studies,
[6]
NASH is considered as the main cause of the steadily increasing incidence of HCC in Western
[7]
industrialized nations . Recent data from a United States cohort show a 10-year cumulative HCC risk of 1.7
per 1000 NAFLD patients. In NASH patients, HCC risk was increased 8.6-fold compared with healthy
subjects. Patients with NAFLD-associated cirrhosis showed a further significantly increased risk of HCC,

© The Author(s) 2021. 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
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