%0 Journal Article
%T Resection of Nonalcoholic Steatohepatitis-Associated Hepatocellular Carcinoma: A Western Experience
%A Brian Shrager
%A Ghalib A. Jibara
%A Parissa Tabrizian
%A Sasan Roayaie
%A Stephen C. Ward
%J International Journal of Surgical Oncology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/915128
%X Introduction. Hepatocellular carcinoma is now known to arise in association with nonalcoholic steatohepatitis. The aim of this study is to examine the clinicopathological features of this entity using liver resection cases at a large Western center. Methods. We retrospectively reviewed all cases of partial liver resection for hepatocellular carcinoma over a 10-year period. We included for the purpose of this study patients with histological evidence of nonalcoholic steatohepatitis and excluded patients with other chronic liver diseases such as viral hepatitis and alcoholic liver disease. Results. We identified 9 cases in which malignancy developed against a parenchymal background of histologically-active nonalcoholic steatohepatitis. The median age at diagnosis was 58 (52每82) years, and 8 of the patients were male. Median body mass index was 30.2 (22.7每39.4)ˋkg/m2. Hypertension was present in 77.8% of the patients and diabetes mellitus, obesity, and hyperlipidemia in 66.7%, respectively. The background liver parenchyma was noncirrhotic in 44% of the cases. Average tumor diameter was 7 . 0 ㊣ 4 . 8 ˋcm. Three-fourths of the patients developed recurrence within two years of resection, and 5-year survival was 44%. Conclusion. Hepatocellular carcinoma may arise in the context of nonalcoholic steatohepatitis, often before cirrhosis has developed. Locally advanced tumors are typical, and long-term failure rate following resection is high. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) is the most prevalent form of chronic liver disease in the West today [1]. NAFLD is associated with the diseases of diabetes mellitus (DM) and obesity and has come to be considered a hepatic manifestation of the metabolic syndrome [2每4]. The most severe form of NAFLD is an inflammatory and fibrosing parenchymal lesion known as nonalcoholic steatohepatitis (NASH) [5]. NASH affects roughly 3% of adults in Western countries [1] and approximately 25每30% of the morbidly obese [6]. A subset of NASH patients will ultimately develop frank cirrhosis, with its potential end-points of liver failure and hepatocellular carcinoma (HCC) [7]. DM and obesity have each been shown to increase risk for liver cancer occurrence or liver cancer-related mortality in large-scale prospective cohort studies [8每11]. It is logical to assume that NASH is the connecting link between these metabolic diseases and liver malignancy. Surprisingly, however, few clinical studies have been devoted to investigating NASH-associated HCC [1, 12每14] (Table 1). Similarly, few surgical series have been published
%U http://www.hindawi.com/journals/ijso/2012/915128/