Relationship between hepatocellular carcinoma, metabolic syndrome and non-alcoholic fatty liver disease: Which clinical arguments? - 08/05/13

Doi : 10.1016/j.ando.2013.02.008

Olivier Rosmorduc
Inserm UMR_S938, service d’hépatologie, hôpital Saint-Antoine, université Pierre- et Marie-Curie (Paris 6), 184, rue du Faubourg Saint-Antoine, 75012 Paris, France

connettersi o creare un account

Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
Articolo gratuito.

Si connetta per beneficiarne

Abstract

Obesity and the metabolic syndrome are growing epidemics associated with an increased risk for many types of cancer. In the liver, inflammatory and angiogenic changes due to insulin resistance and fatty liver disease are associated with an increased incidence of liver cancer. Regardless of underlying liver disease, cirrhosis remains the most important risk factor for hepatocellular carcinoma (HCC) although are cases of HCC arising without cirrhosis raise the possibility of a direct carcinogenesis secondary to Non-alcoholic Fatty Liver Disease (NAFLD). Moreover, metabolic syndrome and its different features may also increase the risk of HCC in the setting of chronic liver diseases of other causes such as viral hepatitis or alcohol abuse. Taking into account all these data, it is necessary to better determine the risk of developing HCC in patients with metabolic syndrome to improve the screening guidelines and develop prophylactic treatments in this setting.

Il testo completo di questo articolo è disponibile in PDF.

Résumé

L’obésité et le syndrome métabolique sont des affections dont la fréquence augmente et qui sont associés à plusieurs types de cancers. Dans le foie, l’inflammation et les modifications angiogéniques lies à l’insulinorésistance et à la stéatose sont associés à une augmentation de l’incidence du carcinoma hépatocellulaire. Indépendamment de la maladie causale sous-jacente, la cirrhose reste le facteur de risque principal du carcinoma hépatocellulaire (CHC) bien que des cas de CHC aient été de plus en plus fréquemment rapports sur foie non cirrhotique, suggérant la possibilité d’une voie de carcinogenèse directe secondaire à la stéatopathie non alcoolique. En outre, le syndrome métabolique et ses différentes manifestations peuvent aussi augmenter le risqué de CHC dans le contexte des maladies chroniques du foie liées à d’autres causes (hépatites virales ou alcool). Tenant compte de ces arguments, il est nécessaire maintenant de mieux évaluer le risque de CHC chez les patients avec syndrome métabolique afin d’améliorer les recommandations pour le dépistage et developer des traitements prophylactiques dans cette situation.

Key Points

•	Obesity and metabolic syndrome (MS) are growing epidemics associated with both an increased risk and worsened outcomes for many types of cancers.
•	The main risk factors for HCC in the setting of Non-alcoholic steatohepatitis (NASH) are age, advanced fibrosis, diabetes mellitus, obesity and iron deposition.
•	Cirrhosis remains the most important risk factor for HCC although cases of HCC may arise without cirrhosis.
•	MS also increases the risk of HCC in the setting of chronic liver diseases of other causes.
•	The determination of the risk of developing HCC patients with MS should improve the screening guidelines and the development of prophylactic treatments in this setting possibly independently of the presence of an underlying chronic liver damage.