演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

NAFLD/NASHを基盤としたHCCの特徴

演題番号 : OSY16-2

[筆頭演者]
橋本 悦子:1 

1:東京女子医科大学・病院・消化器内科

 

Nonalcoholic fatty liver disease (NAFLD) is considered a hepatic manifestation of metabolic syndrome and the most common cause of chronic liver disease. NAFLD comprises 2 clinical entities: NAFL and nonalcoholic steatohepatitis (NASH). NAFL is mostly a benign, while NASH can progress to cirrhosis or even hepatocellular carcinoma (HCC). Obesity and diabetes have been revealed as risk factors for HCC by clinical and experimental studies. A synergistic effect of NALFD/NASH, obesity, and diabetes may play a role in the development of HCC. Epidemiological studies on the etiology of Japanese HCC showed that NAFLD/NASH accounts for 2-20% of HCC and it is the most rapidly rising cause for HCC. Cirrhosis, age, male sex, PNPLA 3 gene polymorphism which is associated with the development and progression of NAFLD/NASH and diabetes are important risk factors for HCC in NAFLD/NASH. The mean age of NALFD-related HCC was around 70 years with male predominance. There was a significantly higher prevalence of obesity and diabetes. 10-75% of NASH-related HCCs occur in non-cirrhotic NASH. However, further studies are required to clarify the true incidence of HCC arising from non-cirrhotic NASH because the diagnosis of NASH is based on histology which can lead selection bias. NAFLD/NASH related HCC was mostly detected by outside surveillance. It was larger and showed more an infiltrative pattern at the time of diagnosis. Histologically, moderately differentiated HCC with trabecular type was the most common. HCC in NALFD/NASH may be of multicentric origin, similar to HCC based on viral hepatitis. These patients had a similar recurrence rate and survival rate compared to those with other etiology (3-year survival rate: 70-80%). In conclusion, there is an urgent need to elucidate pathogenesis and clinical features of NAFLD/NASH. Regular screening for HCC is extremely important, especially in patients with cirrhotic NAFLD/NASH and NAFLD/NASH patients with HCC, even after curative treatment.

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