Nonalcoholic steatohepatitis-associated hepatocellular carcinoma: Our case series and literature review

Table 1 Characteristics of 11 NASH patients with HCC undergoing curative treatment

Case	1	2	3	4	5	6	7	8	9	10	11
Sex (M/F)	M	F	F	M	M	M	F	F	F	F	M
Age (yr)	73	73	83	75	67	68	77	79	73	76	68
BMI	25.0	23.6	21.0	22.3	25.3	24.2	28.1	25.3	23.4	28.8	26.2
Diabetes mellitus (yes/no)	No	Yes	Yes	Yes	No	Yes	Yes	No	No	No	Yes
Dyslipidemia (yes/no)	No	Yes	No	Yes	No	No	No	No	No	No	Yes
Hypertension (yes/no)	No	Yes	No	Yes	Yes	No	Yes	Yes	No	No	Yes
Total bilirubin (mg/dL)	1.6	0.6	0.6	0.7	1.4	0.8	0.8	1.2	0.6	1.3	0.9
Albumin (g/dL)	3.9	4.4	3.2	3.8	4.4	4.3	3.5	4.1	4.4	3.8	4.9
ALT (IU/L)	73	41	22	24	73	18	19	29	41	40	57
γGTP (IU/L)	110	45	36	22	57	33	26	111	124	41	177
Prothrombin time (%)	78.1	95.8	96.3	106.6	90.9	113.4	75.4	77.2	94.0	68.4	86.0
Platelets (× 104/μL)	10.1	15.0	15.1	27.8	14.3	27.2	9.3	13.9	13.0	5.5	13.4
Child-Pugh classification (A/B)	A	A	A	A	A	A	B	A	A	A	A
AFP (ng/mL)	8.7	4.6	40.6	9181.6	1.7	1.8	1957.0	7.9	13.0	8.8	16.2
DCP (mAU/mL)	31	10	2066	1765	64	10	718	19	571	106	2930
Anti-HBc (+/-)	+	-	-	-	-	+	-	-	-	+	-
Treatment (RFA/MCT/Ope)	RFA	RFA	Ope	Ope	Ope	Ope	Ope	Ope	RFA	MCT	Ope
No. of nodules (1/2/3)	3	1	1	1	1	1	1	1	3	2	1
Size of largest tumor (cm)	1.8	1.7	5.0	5.0	3.6	4.5	3.2	2.0	2.5	3.0	4.4
Stage of fibrosis (F1/F2/F3/F4)	F4	F1	F4	F1	F1	F1	F4	F4	F1	F3	F1

NASH: Nonalcoholic steatohepatitis; HCC: Hepatocellular carcinoma; M: Male; F: Female; BMI: Body mass index; ALT: Alanine aminotransferase; γGTP: γ-glutamyltransferase; AFP: α-fetoprotein; DCP: Des-γ-carboxy prothrombin; Anti-HBc: HBc antibody; RFA: Radio-frequency ablation; MCT: Microwave coagulation therapy; Ope: Operation.

Table 2 Clinical features of cases with NASH-associated HCC in previous reports

Author	No. of cases	Age (yr)	Sex	Underlying disease	Liver histology	No. of nodules	Tumor size (cm)	Treatment
Powell et al[1]	1	57	F	DM	LC	Mul	NR	Ope
Zen et al[17]	1	72	F	DM	LC	Mul	1.4	NR
Orikasa et al[18]	1	67	F	DM	LC	Sol	2.6	NR
Cotrim et al[19]	1	66	M	OB, DM	LC	Sol	3.0	PEI
Bencheqroun et al[20]	1	68	M	OB	Non-LC	NR	NR	NR
Mori et al[21]	1	76	M	OB, DM	LC	Sol	1.9	RFA
Bullock et al[22]	2	64, 74	M (2)	OB (2), DM (2)	Non-LC (2)	Sol (2)	NR	Ope (2)
Cuadrado et al[23]	2	69, 74	M (2)	OB (2), DM (2)	LC, Non-LC	Sol (2)	NR	RFA (2)
Sato et al[24]	1	64	M	OB, DL	Non-LC	Sol	13.0	None
Ichikawa et al[25]	2	60, 66	M, F	OB (1), DL (1)	Non-LC (2)	Sol (2)	1.5, 2.5	Ope (2)
Ikeda et al[26]	1	69	M	OB, DM	LC	Sol	4.5	Ope
Tsutsumi et al[27]	2	46, 68	M, F	NR	LC (2)	Sol (2)	NR	NR
Hashizume et al[2]	9	45-82	M (5), F (4)	OB (5), DM (7), DL (8)	LC (6), Non-LC (3)	Sol (8), Mul (1)	1.5-7.0	Ope (6), RFA (2), TAE (1)
Hai et al[28]	2	65, 72	M (2)	OB (2), DM (2)	LC, Non-LC	Sol (2)	4.0, 6.0	Ope (2)
Maeda et al[29]	3	52-68	M (2), F (1)	NR	LC (3)	Sol (3)	1.3-5.0	Ope (3)
Kawada et al[30]	6	59-81	M (3), F (3)	OB (2), DM (3), DL (1)	Non-LC (6)	Sol (6)	1.3-5.8	Ope (6)
Hashimoto et al[3]	34	54-89	M (21), F (13)	OB (62%), DM (74%), DL (29%)	F1-2 (22%), F3-4 (88%)	Sol (24), Mul (10)	NR	NR
Malik et al[4]	17	47-72	M (12), F (5)	OB (17), DM (12)	LC (17)	Sol (8), Mul (9)	1.1-8.0	LT (17)
Chagas et al[31]	7	35-77	M (4), F (3)	OB (7), DM (3), DL (2)	LC (6), Non-LC (1)	Sol (4), Mul (3)	2.8-5.2	Ope (2), PEI (1), TAE (3), LT (1)

HCC: Hepatocellular carcinoma; DM: Diabetes mellitus; OB: Obesity; DL: Dyslipidemia; LC: Liver cirrhosis; Mul: Multiple; Sol: Solitary; Ope: Surgical operation; PEI: Percutaneous ethanol injection; RFA: Radiofrequency ablation; TAE: Transarterial embolization; LT: Liver transplantation; NR: Not reported.