tailieunhanh - Fatty Liver Disease : Nash and Related Disorders - part 9

1 ung thư biểu mô tế bào gan (HCC) có thể xảy ra ở những bệnh nhân với xơ gan liên quan đến NASH. Nghiên cứu trong tương lai cần để đánh giá tỷ lệ so sánh đến xơ gan từ aetiologies khác. 2 Trong hầu hết các trường hợp HCC 'NASH liên quan, xơ gan cơ bản là không được chẩn đoán | 22 Fatty Liver Disease NASH and Related Disorders Edited by Geoffrey C. Farrell Jacob George Pauline de la M. Hall Arthur J. McCullough Copyright 2005 Blackwell Publishing Ltd Hepatocellular carcinoma in NAFLD Vlad Ratziu Thierry Poynard Key learning points 1 Hepatocellular carcinoma HCC can occur in patients with NASH-related cirrhosis. Future studies need to assess its incidence in comparison to cirrhosis from other aetiologies. 2 In most cases of NASH-associated HCC the underlying cirrhosis was undiagnosed despite a longstanding history of abnormal liver tests and obesity and or diabetes. 3 Most patients with NASH-associated HCC are not eligible for curative treatment as a result of the delay in diagnosis. 4 An increased risk for HCC has been demonstrated in both obese and diabetic subjects. This risk is most likely independent of alcohol consumption viral hepatitis or a known history of cirrhosis. 5 Experimental data demonstrated the existence of preneoplastic changes in the steatotic liver prior to the occurrence of inflammation and cirrhosis. Abstract Large cohort and case-control studies have shown an increased risk of liver cancer mainly hepatocellular carcinoma HCC in obese and diabetic persons. While concomitant hepatic viral infections or alcohol consumption could explain part of this association a variable but significant number of cases of HCC still occur in the absence of any epidemiologically linked carcinogenic associations. As obesity and diabetes predispose to non-alcoholic steatohepatitis NASH the carcinogenic potential of this condition has come under focus. Several case series have documented the occurrence of HCC in NASH-associated cirrhosis. A salient feature of these observations is that diagnosis was often made at an advanced stage. Indeed HCC and the underlying liver disease were often diagnosed simultaneously despite a known but long overlooked elevation in liver tests. In most cases this hampered efforts for curative therapy. To date no

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