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Epidemiology and risk-stratification of NAFLD-associated HCC
Journal of Hepatology ( IF 25.7 ) Pub Date : 2021-08-25 , DOI: 10.1016/j.jhep.2021.08.012
George N Ioannou 1
Affiliation  

Non-alcoholic fatty liver disease (NAFLD) is projected to become the leading cause of hepatocellular carcinoma (HCC) in many countries. Many risk factors for NAFLD are also independently associated with HCC, including obesity, diabetes, Hispanic ethnicity and genetic polymorphisms in PNPLA3, TM6SF2, GCKR, MBOAT7 and HSD17B13. Steatosis-related lipotoxicity and oxidative DNA damage can induce hepatocarcinogenesis. These factors may explain the association between NAFLD and HCC, especially in the absence of cirrhosis. In fact, NAFLD/NASH is a leading cause of HCC in the absence of cirrhosis. Identifying patients with pre-cirrhotic NAFLD who have a high enough HCC risk to justify HCC screening represents one of the greatest clinical challenges in NAFLD. Validated models that combine multiple risk factors and fibrosis stage into “HCC risk calculators” are not yet available for patients with NAFLD. Development of such tools would enable risk stratification, identification of high-risk patients even in the absence of cirrhosis, and individualised (risk-based) surveillance strategies.



中文翻译:

NAFLD 相关 HCC 的流行病学和风险分层

在许多国家,非酒精性脂肪性肝病 (NAFLD) 预计将成为肝细胞癌 (HCC) 的主要原因。NAFLD 的许多危险因素也与 HCC 独立相关,包括肥胖、糖尿病、西班牙裔和PNPLA3TM6SF2GCKRMBOAT7HSD17B13中的基因多态性. 脂肪变性相关的脂毒性和氧化性 DNA 损伤可诱导肝癌发生。这些因素可以解释 NAFLD 与 HCC 之间的关联,尤其是在没有肝硬化的情况下。事实上,在没有肝硬化的情况下,NAFLD/NASH 是 HCC 的主要原因。识别具有足够高 HCC 风险以证明 HCC 筛查合理的肝硬化前 NAFLD 患者是 NAFLD 最大的临床挑战之一。NAFLD 患者尚无将多种风险因素和纤维化阶段结合到“HCC 风险计算器”中的经过验证的模型。此类工具的开发将使风险分层、即使在没有肝硬化的情况下也能识别高风险患者以及个体化(基于风险)监测策略成为可能。

更新日期:2021-08-25
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