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Hepatocellular Carcinoma in the Setting of Non-cirrhotic Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome: US Experience

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Abstract

Background

Type 2 diabetes mellitus, obesity, and the metabolic syndrome (MS) have been growing in prevalence in the USA and are independent risk factors for the development of hepatocellular carcinoma (HCC). Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of the MS, with or without nonalcoholic steatohepatitis (NASH) can predispose to HCC in the absence of cirrhosis or advanced fibrosis. Nevertheless, the US literature investigating non-cirrhotic HCC in the setting of NAFLD/NASH and MS is lacking.

Aim

To describe a retrospective case series of patients who developed HCC without cirrhosis in the setting of NAFLD/NASH or features of the MS.

Methods

We identified NAFLD/NASH-associated HCC cases arising in the absence of cirrhosis between January 2010 and September 2012 from a tumor board database at Brooke Army Medical Center (BAMC).

Results

Of 44 cases of HCC reviewed, six cases of non-cirrhotic HCC associated with NAFLD/NASH and/or MS were identified. Only one patient underwent partial hepatectomy with curative intent. The other five might have been candidates for potential curative partial hepatectomy or liver transplantation had they been diagnosed earlier.

Conclusion

Our case series highlights the development of NAFLD/NASH and MS-associated HCC in the absence of cirrhosis in the US population and raises the important question of HCC screening for this at-risk group.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Liver Transplant Program, Stanford University School of Medicine, 750 Welch Road, Suite #210, Stanford, CA, 94304, USA

    Ryan B. Perumpail & Aijaz Ahmed

  2. Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, 1411 East 31st Street, Oakland, CA, 94602, USA

    Robert J. Wong

  3. Division of Gastroenterology, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA

    Stephen A. Harrison

Authors
  1. Ryan B. Perumpail
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  2. Robert J. Wong
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  3. Aijaz Ahmed
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  4. Stephen A. Harrison
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Correspondence to Ryan B. Perumpail.

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Disclaimer: The opinions in this manuscript do not constitute endorsement by San Antonio Military Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense, or the U.S. Government of the information contained therein.

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Perumpail, R.B., Wong, R.J., Ahmed, A. et al. Hepatocellular Carcinoma in the Setting of Non-cirrhotic Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome: US Experience. Dig Dis Sci 60, 3142–3148 (2015). https://doi.org/10.1007/s10620-015-3821-7

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  • DOI: https://doi.org/10.1007/s10620-015-3821-7

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