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Risk Stratification for Hepatocellular Carcinoma in Patients with Non-alcoholic Fatty Liver Disease

  • Hepatic Cancer (N Parikh, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purposeof Review

This review aims to supply up-to-date recommendations on risk stratification for hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD).

Recent Findings

NAFLD is the most rapidly growing cause of HCC in the USA. HCC surveillance in patients with NAFLD remains a clinical challenge due to the large global burden of NAFLD, limitations in surveillance modalities, and the widely recognized possibility of HCC development in NAFLD in the absence of cirrhosis.

Summary

Based on fibrosis staging, HCC screening in NAFLD is recommended in cirrhosis, considered in advanced fibrosis, and not recommended in the absence of advanced fibrosis. Though liver biopsy is the gold standard for staging, evidence of advanced fibrosis warranting HCC surveillance in NAFLD can be based on 2 concordant noninvasive tests. Those meeting recommended criteria for HCC surveillance should undergo imaging with or without serum α-fetoprotein levels every 6 months at minimum.

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Abbreviations

AASLD :

American Association for the Study of Liver Diseases

AFP :

α-Fetoprotein

AGA :

American Gastroenterological Association

ALT :

Alanine aminotransferase

APRI :

Aspartate aminotransferase-to-platelet ratio index

AST :

Aspartate aminotransferase

AUROC :

Area under the receiver operating curve

BMI :

Body mass index

CT :

Computed tomography

EASL :

European Association for the Study of the Liver

F3 :

Fibrosis stage 3

FIB-4 :

Fibrosis-4 Score

HCC :

Hepatocellular carcinoma

HCV :

Hepatitis C virus

HFS :

Hepamet Fibrosis Score

HOMA :

Homeostatic model assessment

LI-RADS :

Liver Imaging Reporting and Data System

MASEF :

Metabolomics-Advanced StEatohepatitis Fibrosis

MRE :

Magnetic resonance elastography

MRI :

Magnetic resonance imaging

NAFLD :

Non-alcoholic fatty liver disease

NASH :

Non-alcoholic steatohepatitis

NFS :

NAFLD Fibrosis Score

US :

Ultrasonography

VCTE :

Vibration-controlled transient elastography

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Author information

Authors and Affiliations

  1. Department of Medicine, CA, Los Angeles, USA

    Emily Truong

  2. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Emily Truong

  3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Cheng Han

  4. National University of Singapore, Singapore, Singapore

    Mark Muthiah

  5. Houston Liver Institute, 1155 Dairy Ashford Suite 200, Houston, TX, 77079, USA

    Mazen Noureddin

  6. Houston Research Institute, 1155 Dairy Ashford Suite 200, Houston, TX, 77079, USA

    Mazen Noureddin

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  4. Mazen Noureddin
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Contributions

ET interpreted the data and drafted the manuscript. CH, MM, and MN critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mazen Noureddin.

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Conflict of Interest

Mazen Noureddin has been on the advisory board/consultant for 89BIO, Altimmune, Gilead, cohBar, CytoDyn, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Madrgial, NorthSea, Prespecturm, Terns, Sami-Sabina group, Siemens and Roche diagnostic; MN has received research support from Allergan, BMS, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; MN is a shareholder or has stocks in Anaetos, Chrownwell, Ciema, Rivus Pharma, and Viking.

Emily Truong, Cheng Han, and Mark Muthiah declare that they have no conflict of interest.

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Truong, E., Han, C., Muthiah, M. et al. Risk Stratification for Hepatocellular Carcinoma in Patients with Non-alcoholic Fatty Liver Disease. Curr Hepatology Rep 22, 1–8 (2023). https://doi.org/10.1007/s11901-023-00595-7

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