Nonalcoholic Fatty Liver Disease progresses to HCC in the absence of apparent Cirrhosis

Background and Aims: NAFLD is the most common liver disease in developed countries, and accumulating evidence suggests it as the hepatic manifestation of the metabolic syndrome. Although the published prevalence of hepatocellular carcinoma (HCC) is low in NAFLD/NASH patients, most of these data have been derived from areas endemic for viral hepatitis. Thus we aimed to analyze a european collective of patients with a significant proportion of NAFLD associated HCC. Methods: 162 adults with HCC between 02/2007 and 03/2008 were recruited into the study. The underlying etiologies, the prevalence of the metabolic syndrome and related features within each group were determined. Results: In patients with NAFLD/NASH-associated HCC a higher prevalence of metabolic features (type 2 diabetes mellitus, hypertension, dyslipidemia, coronary artery disease) was found, compared to non-NAFLD/NASH-HCC. Intriguingly, for a significant number (41.7%; p<0.005) of individuals with NAFLD/NASH-HCC no evidence of cirrhosis could be obtained. Patients with alcohol-induced liver disease also displayed many features (14/19, 73.7%) of the metabolic syndrome, although, in contrast to NAFLD/NASH-HCC, alcohol-associated HCC was highly associated with cirrhosis (95.0%; p=0.064). Conclusion: NAFLD/NASH as the hepatic entity of the metabolic syndrome may itself pose a risk factor for HCC, even in the absence of cirrhosis. The metabolic syndrome may also contribute to development of HCC among those with alcoholic liver disease. Increased awareness of liver manifestations in patients exhibiting metabolic syndrome may warrant early screening for HCC.