Abstract
Although most hepatocellular carcinoma (HCC) is related to viral infection, there is a substantial population of HCC patients (5-20%) who are negative for both markers of hepatitis B virus and hepatitis C virus infection [non-B, non-C (NBNC) hepatitis] in Japan and the incidence of NBNC-HCC has recently tended to increase. The most common cause of liver disease in developed countries is non‑alcoholic fatty liver disease (NAFLD), which includes non‑alcoholic steatohepatitis (NASH) and its related complications. Increased body mass index and diabetes mellitus are associated with developing NAFLD and NASH, which is a severe form of NAFLD. Furthermore, increasing clinical evidence supports the fact that NAFLD and NASH can progress to liver cirrhosis and even HCC. A detailed understanding of the epidemiology, etiology, molecular mechanism, clinical features and prognosis of NBNC-HCC could improve our screening and therapy of this disease. In this review, we primarily focus on clinical aspects of NBNC-HCC and refer to our current knowledge of this cancer.
Highlights
Most hepatocellular carcinoma (HCC) is related to viral infection, there is a substantial population of HCC patients (5-20%) who are negative for both markers of hepatitis B virus and hepatitis C virus infection [non-B, non-C (NBNC) hepatitis] in Japan and the incidence of NBNC-HCC has recently tended to increase
We primarily focus on clinical aspects of NBNC-HCC and refer to our current knowledge of this cancer
Most HCC still occurs in patients with chronic hepatitis C in Japan, the incidence of HCV-related HCC has been decreasing in recent years because of the improvement of therapy for chronic hepatitis C and a decrease in the number of patients newly diagnosed with chronic hepatitis C [6,20,21,22]
Summary
The alcohol consumption criterion for defining alcoholic liver disease as proposed by the Japanese Study Group on Alcoholic Liver Disease is an ethanol intake of >70 g/day for >5 years. As compared with Western countries, the prevalence of alcohol‐related HCC is lower in Japan [19]. According to a meta-analysis from Italy, hazard ratios (HRs) for HCC development of 1.19 [95% confidence interval (CI)=1.12-1.27], 1.40 (95% CI=1.25‐1.56), and 1.81 (95% CI=1.50-2.19) were associated with alcohol consumption of 25, 50 and 100 g/day, respectively. This indicates that the risk of HCC development is proportional to the amount of alcohol consumed, the risk in those who consume low or moderate levels remains unclear [25]
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