Expanding the natural history of nonalcoholic steatohepatitis: From cryptogenic cirrhosis to hepatocellular carcinoma

Bugianesi, Elisabetta; Leone, Nicola; Vanni, Ester; Marchesini, Giulio; Brunello, F.; Carucci, P.; Musso, Alessandro; Paolis, Paolo De; Capussotti, Lorenzo; Salizzoni, Mauro; Rizzetto, M.

doi:10.1053/gast.2002.34168

Cited by 1,320 publications

(927 citation statements)

References 39 publications

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“…These findings support the hypothesis that NASH is a risk factor for HCC and that it may explain a considerable proportion of cryptogenic HCC cases. In these studies, however, the prevalence of cryptogenic HCC was 7% (Bugianesi et al, 2002) and 9% (Regimbeau et al, 2004), much lower than the 29% reported in a USA study with a high prevalence of obesity and obesity-related metabolic disorders (Marrero et al, 2002).…”

Section: Non-alcoholic Steatohepatitis and Hepatocellular Carcinomamentioning

confidence: 59%

“…Cryptogenic cirrhosis accounts for 3.5% of all cases of cirrhosis in Italy . In an Italian study, 23 patients with cryptogenic cirrhosis and HCC were compared with 115 age-matched patients with viral-and alcohol-associated cirrhosis and HCC: the former were more likely to have clinical features suggestive of NASH, including precirrhosis BMI>30 kg/m 2 (41 vs 16%), type II diabetes (50 vs 20%), dyslipidemia and insulin resistance (Bugianesi et al, 2002). Similarly, patients with cryptogenic chronic liver disease and HCC who underwent surgical resection were compared with matched patients with alcohol-and chronic viral hepatitis-related HCC in a French study: patients with cryptogenic chronic liver disease, compared to patients with alcohol abuse and those with chronic viral hepatitis, had a significantly higher prevalence of obesity (50 vs 17 and 14%), diabetes (56 vs 17 and 11%) and >20% steatosis (61 vs 17 and 19%) (Regimbeau et al, 2004).…”

Section: Non-alcoholic Steatohepatitis and Hepatocellular Carcinomamentioning

confidence: 99%

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Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediatehigh prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably cofactors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

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Section: Non-alcoholic Steatohepatitis and Hepatocellular Carcinomamentioning

confidence: 59%

Section: Non-alcoholic Steatohepatitis and Hepatocellular Carcinomamentioning

confidence: 99%

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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“…Along similar lines, the incidence of cryptogenic HCC has also been increasing across the 2 eras. Cryptogenic HCC often represents “burnt out” nonalcoholic steatohepatitis (NASH), where a significant number of these patients have the clinical phenotype consistent with NASH, such as higher prevalence of metabolic risk factors 28, 29. Socioeconomic changes seen with rapid modernization, increasing affluence, and a shift to a more sedentary lifestyle and obesogenic dietary patterns predispose to NASH 11, 30.…”

Section: Discussionmentioning

confidence: 99%

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

Goh

Chang

et al. 2017

Hepatology Communications

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Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

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“…4,7,46,47 Patients with NAFLD are at increased risk for HCC, but this risk is likely limited to those with advanced fibrosis and cirrhosis. [48][49][50][51][52][53] Several studies investigated the natural history of NASH cirrhosis in comparison to patients with hepatitis C cirrhosis. [54][55][56][57] One large prospective US-based study 55 observed a lower rate of decompensation and mortality in patients with NASH cirrhosis as compared to patients with hepatitis C cirrhosis.…”

Section: Natural Historymentioning

confidence: 99%

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

et al. 2012

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Expanding the natural history of nonalcoholic steatohepatitis: From cryptogenic cirrhosis to hepatocellular carcinoma

Cited by 1,320 publications

References 39 publications

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

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