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CC BY 4.0 · Brazilian Journal of Oncology 2018; 14(47): e-BJO20181447A175
DOI: 10.26790/BJO20181447A175
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Exploring the link between anabolic-androgenic steroids abuse for performance improvement and hepatocellular carcinoma: a literature review

Explorando a relação entre hepatocarcinoma e o abuso de esteroides anabolizantes para otimização da aptidão física: uma revisão de literatura
Rafael Corrêa Coelho
1   Hemato-Oncology Department, Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul, RS, Brazil
,
Gustavo dos Santos Fernandes
2   Hospital Sirio-Libanês, Brasília, DF, Brazil
,
Cinthya Sternberg
3   Graduate Program of Anatomical Pathology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Financial support none to declare.
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ABSTRACT

Introduction: Hepatocellular carcinoma (HCC) corresponds to 90% of primary malignant liver cell carcinomas and is a leading cause of cancer-related death worldwide.

Objective: This compilation of cases aimed to identify evidence of correlation between anabolic androgen steroids (AAS) abuse for performance improvement by healthy subjects and HCC.

Methods: We performed a literature review and identified 935, 1148, 12 and 3 articles in Pubmed, Embase, Scopus and Lilacs, respectively. Only studies, reviews and case reports evaluating the association between androgens and hepatocarcinoma were included with no restrictions in time span or language. Further on, we excluded studies and case reports which patients were receiving therapeutic androgens and collected data only of those reporting androgen intake to improve physical performance.

Results: Six articles fulfilled the inclusion criteria, excluding the duplicates. HCC onset after AAS abuse seems to occur at earlier ages than those related to chronic hepatitis B/C, chronic alcohol consumption and nonalcoholic steatohepatitis (NASH). Timeframe ranged from two to seven years in the cases reports presented here. Many AAS subtypes were used by patients depicted in the case reports, so it is difficult to conclude if a specific AAS is safer or more harmful than the other. Carcinogenic mechanisms are poorly understood, but pre-clinical evidence shows that androgen receptors and oxidative stress may play a pivotal role in its development.

Conclusion: The evidence that HCC has been linked to long term AAS abuse for performance improvement is scant but some association is suggested. AAS must be taken only under specialized supervision and the putative correlation with HCC calls for public policies to make high risk populations aware of the risks of misuse and self-administration.

RESUMO

Introdução: O hepatocarcinoma (HC) corresponde a 90% das neoplasias malignas pri-márias do fígado, sendo uma importante causa de morte relacionada a neoplasias no mundo.

Objetivo: Esta compilação de casos tem como intenção identificar uma possível correlação entre hepatocarcinoma e o abuso de esteroides anabolizantes (EA) para oti-mização da aptidão física em indivíduos saudáveis.

Métodos: Foi realizada uma revisão de literatura na qual se identificaram 935, 1148, 12 e 3 artigos no Pubmed, Embase, Scopus e Lilacs, respectivamente. Foram incluídos, inicialmente, apenas estudos clínicos, revisões de literatura e relatos de caso avaliando a associação entre EA e HC, sem res-trições quanto ao período e linguagem. Excluíram-se os estudos clínicos e os relatos de caso nos quais os pacientes receberam EA com objetivo terapêutico, sendo, portanto, co-letados dados apenas dos artigos reportando o uso de EA para melhora da aptidão física.

Resultados: Seis artigos preencheram os critérios de inclusão, excluindo-se as duplicações. O surgimento de HC após abuso de EA parece ocorrer em idades mais precoces quan-do se compara com o HC relacionado aos vírus da hepatite B e C, consumo crônico de álcool e esteato-hepatite não alcoólica (NASH). O intervalo para surgimento da neoplasia a partir do início do abuso de EA variou entre 2 a 7 anos nos relatos de caso descritos nesta revisão. Diversos tipos de EA foram utilizados pelos pacientes descritos nos relatos de caso, o que torna difícil qualquer conclusão sobre qual EA teria um maior perfil de se-gurança ou risco. Os mecanismos de carcinogênese são pouco conhecidos, mas evidências pré-clínicas sugerem que os androgênios e o estresse oxidativo podem estar diretamen-te relacionados ao desenvolvimento de HC.

Conclusão: As evidências relacionando HC e o abuso de EA para otimização da aptidão física são escassas, contudo os dados presentes da literatura sugerem que algum grau de associação é possível. EA devem ser uti-lizados apenas sob supervisão especializada e a possibilidade de haver uma associação com HC reforça a necessidade de políticas públicas para alertar às populações de maior risco sobre os perigos do uso incorreto e sem supervisão de esteroides anabolizantes.

Keywords:

Hepatocellular carcinoma - Anabolic androgen steroids - Testosterone congeners

Descritores:

Carcinoma hepatocellular - Esteroides andrógenos anabólicos - Congêneres da testosterona


Publication History

Received: 20 December 2017

Accepted: 23 March 2018

Article published online:
25 February 2025

© 2018. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Rafael Corrêa Coelho, Gustavo dos Santos Fernandes, Cinthya Sternberg. Exploring the link between anabolic-androgenic steroids abuse for performance improvement and hepatocellular carcinoma: a literature review. Brazilian Journal of Oncology 2018; 14: e-BJO20181447A175.
DOI: 10.26790/BJO20181447A175
 

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