Dear Colleagues:
the first table of the article describes the differences between cirrhotic and non cirrhotic hepatocellular carcinomas and notes that when the first is caused by alcoholic or viral insults to the organ, the later is, among other causes, derived of metabolic alterations. This statement, I consider should be revised because it has been widely studied the association of non-alcoholic fat liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as cirrhosis causatives and their close link to metabolic origins.
Metabolic syndrome is a constellation of problems including obesity, dyslipidemia, diabetes, and insulin resistance These diseases are associated with both increased risk for, and worsened outcomes of many types of cancer. In the liver, inflammatory and angiogenic changes due to underlying insulin resistance and fatty liver disease will likely lead to increased numbers of patients with HCC in the near future. Much work needs to be done to define more clearly the risks for development of HCC in those with underlying metabolic syndrome, the best methods of screening those at risk, and ultimately, the best treatments targeting the underlying mechanisms of pathogenesis.
Dear Raul
This issue (non-cirrhotic derived hepatocellular carcinoma) has been extensively reviewed. Currently, is it known that NAFLD in around 5-7% of cases, may progress to HCC without passing through cirrhotic state. Effectively, as you say, most frequent causes of HCC is cirrhosis secondary to alcohol and viruses. Nevertheless, the incidence of non-cirrhotic derived HCC is increasing nowadays I think due to the epidemics of obesity and diabetes mellitus The precise pathophysiologic mechanism of this association (NAFLD without cirrhosis - HCC) is not known. Probably, inflammation chemical mediators, adipokine and proliferative factors have some participation. Best regards
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