Abstract
Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of hepatocellular carcinoma (HCC), liver-related mortality, and liver transplantation. There is sufficient epidemiological cohort data to recommend the surveillance of patients with NAFLD based upon the incidence of HCC. The American Gastroenterology Association (AGA) expert review published in 2020 recommends that NAFLD patients with cirrhosis or advanced fibrosis estimated by non-invasive tests (NITs) consider HCC surveillance. NITs include the fibrosis-4 (FIB-4) index, the enhanced liver fibrosis (ELF) test, FibroScan, and MR elastography. The recommended surveillance modality is abdominal ultrasound (US), which is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with NAFLD. In NAFLD patients with a high likelihood of having an inadequate US, or if an US is attempted but inadequate, CT or MRI may be utilized. The GALAD score, consisting of age, gender, AFP, the lens culinaris-agglutinin-reactive fraction of AFP (AFP-L3), and the protein induced by the absence of vitamin K or antagonist-II (PIVKA-II), can help identify a high risk of HCC in NAFLD patients. Innovative parameters, including a Mac-2 binding protein glycated isomer, type IV collagen 7S, free apoptosis inhibitor of the macrophage, and a combination of single nucleoside polymorphisms, are expected to be established. Considering the large size of the NAFLD population, optimal screening tests must meet several criteria, including high sensitivity, cost effectiveness, and availability.
Highlights
The control of viral hepatitis (hepatitis B virus (HBV) and hepatitis C virus (HCV)) has The control ofand viralthe hepatitis (hepatitisB virus (HBV) and hepatitis C carcinoma virus (HCV))has become become possible, so-called non-HBV non-HCV hepatocellular (NBNC-hepatocellular carcinoma (HCC))has possible, and non-HBV has become become 1/3 ofthe theso-called total number of HCC cases inhepatocellularJapan [1]
We previously reported that a combination of PNPLA3 and dysferlin in patients with nonalcoholic fatty liver disease factors (NAFLD) in Japan presented a high risk of developing HCC for both risk alleles [87], but further cases need to be studied for validation
The surveillance of HCC is unreasonable for all patients with NAFLD, who are estimated to total more than 2 billion worldwide
Summary
The control of viral hepatitis (hepatitis B virus (HBV) and hepatitis C virus (HCV)) has now. Has become become possible, so-called non-HBV non-HCV hepatocellular (NBNC-HCC). Has possible, and non-HBV has become become 1/3 ofthe theso-called total number of HCC cases inhepatocellular. It has been proposed to change proposed to change this name to metabolic dysfunction associated fatty liver disease (MAFLD). HCV, portends the high aprevalence of HCC theorpopulation underlies the of NAFLD in population the importance of NAFLD inpoor the development ofaHCC [12]. Importance ofthe in theunderlies development of HCC [12]. NAFLD-related aresurveillance not diagnosed through manyItaly patients withUnited. Will progress from NASH to liver cirrhosis. The incident rate of HCC 10 years after liver cirrhosis is about 25%. Out of 100 NAFLD patients, it is rare for 1–2 people with NAFLD to develop HCC. The authors have copyright of this figure [10]
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