Published online Apr 18, 2017. doi: 10.4254/wjh.v9.i11.533
Peer-review started: July 31, 2016
First decision: September 8, 2016
Revised: February 25, 2017
Accepted: March 14, 2017
Article in press: March 14, 2017
Published online: April 18, 2017
With the prevalence of hepatitis C virus expected to decline, the proportion of hepatocellular carcinoma (HCC) related to non-alcoholic steatohepatitis (NASH) is anticipated to increase exponentially due to the growing epidemic of obesity and diabetes. The annual incidence rate of developing HCC in patients with NASH-related cirrhosis is not clearly understood with rates ranging from 2.6%-12.8%. While multiple new mechanisms have been implicated in the development of HCC in NASH; further prospective long-term studies are needed to validate these findings. Recent evidence has shown a significant proportion of patients with non-alcoholic fatty liver disease and NASH progress to HCC in the absence of cirrhosis. Liver resection and transplantation represent curative therapeutic options in select NASH-related HCC patients but have placed a significant burden to our healthcare resources and utilization. Currently NASH-related HCC is the fastest growing indication for liver transplant in HCC candidates. Increased efforts to implement effective screening and preventative strategies, particularly in non-cirrhotic NASH patients, are needed to reduce the future impact imposed by NASH-related HCC.
Core tip: Non-alcoholic steatohepatitis (NASH) is anticipated to account for a greater proportion of hepatocellular carcinoma (HCC) incidence due to the growing epidemic of obesity and diabetes. Currently NASH-related HCC is the fastest growing indication for liver transplant in HCC candidates. Increased efforts to implement effective screening and preventative strategies particularly in non-cirrhotic NASH patients possibly based on genetic susceptibility are needed to reduce the future impact imposed by NASH-related HCC.