Non-alcoholic Fatty Liver Disease Associated Hepatocellular Carcinoma

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases ranging from non-alcoholic fatty liver and non-alcoholic steatohepatitis to its more severe forms such as liver fibrosis and cirrhosis. The incidence of hepatocellular carcinoma (HCC) increases as NAFLD progresses to the more severe forms. As prevalence of obesity and metabolic syndrome rising in North America, NAFLD associated HCC is becoming the leading cause of HCC. Different from other causes of HCC, altered metabolic state and its impact on immune response play an important role in the pathogenesis of NAFLD associated HCC. Currently, immune checkpoint inhibitors and combination therapy are first-line treatments of advanced HCC regardless of etiologies. Given the rising incidence of NAFLD associated HCC and its unique pathogenesis, future clinical trials should assess whether HCC etiology—NAFLD in particular—influence the safety and efficacy of a given treatment.