Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 3842-3848
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3842
Hepatocellular carcinoma and metabolic syndrome: The times are changing and so should we
Georgios Tsoulfas
Georgios Tsoulfas, Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Author contributions: Tsoulfas G interpreted the literature and wrote the manuscript.
Conflict-of-interest statement: Georgios Tsoulfas reports no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Associate Professor, Department of Surgery, Aristotle University of Thessaloniki, University Campus, Thessaloniki 54124, Greece. tsoulfasg@auth.gr
Telephone: +30-697189190 Fax: +30-2310-3320222
Received: April 28, 2019
Peer-review started: April 28, 2019
First decision: May 24, 2019
Revised: June 3, 2019
Accepted: June 25, 2019
Article in press: June 26, 2019
Published online: August 7, 2019
Processing time: 102 Days and 19.6 Hours
Abstract

Although hepatocellular carcinoma (HCC) is as prevalent as ever as a cancer-related mortality, and some would even argue that it is increasing, the pattern of its etiologies has been changing. Specifically, the domination of viral hepatitis C virus is being overcome, partly because of the emergence of the antiviral treatments, and partly because of the significant increase, especially in developed countries, of the combination of obesity, diabetes, metabolic syndrome, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. This editorial will explore the interconnection of this group of diseases and how they are linked to HCC. More importantly, it will argue that this shift in HCC etiology essentially means that we have to change how we approach the treatment of HCC, by changing our focus (and resources) to earlier stages of the disease development in order to prevent the appearance and progression of HCC.

Keywords: Hepatocellular carcinoma; Diabetes; Obesity; Steatosis; Non-alcoholic fatty liver disease; Body-mass index; Non-alcoholic steatohepatitis

Core tip: There is a changing landscape whereby metabolic syndrome and non-alcoholic fatty liver disease and non-alcoholic steatohepatitis have replaced hepatitis viral infections and alcohol as the predominant causes of cirrhosis and hepatocellular carcinoma (HCC) on the global scale. As such, we need to change the treatment focus and address metabolic syndrome and its elements in an effort to intervene more timely in the development of cirrhosis and HCC.