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Gastroenterology. 2020 Jan 30. pii: S0016-5085(20)30127-X. doi: 10.1053/j.gastro.2019.12.053. [Epub ahead of print]

AGA Clinical Practice Update on Screening and Surveillance for Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: Expert Review.

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Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology Department of Medicine, University of California San Diego, La Jolla, California; Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California. Electronic address:
Yale Liver Center and Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
Southern California Permanente Medical Group, San Diego, California; Division of Gastroenterology and Hepatology, Veterans Affairs San Diego Healthcare System, San Diego, California.
Department of Medicine, Baylor College of Medicine, Houston, Texas.


Nonalcoholic fatty liver disease (NAFLD) is a leading etiology for chronic liver disease with immense public health impact, affecting >25% of the US and global population, of whom up to 1 in 4 may have nonalcoholic steatohepatitis (NASH). NASH is associated with significant morbidity and mortality due to complications of liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Recent data confirm that HCC represents the fifth most common cancer and second leading cause of cancer-related death worldwide, and NAFLD has been identified as a rapidly emerging risk factor for this malignancy. NAFLD-associated liver complications are projected to become the leading indication for liver transplantation in the next decade. Despite evidence that NAFLD-associated HCC may arise in the absence of cirrhosis, is often diagnosed at advanced stages, and is associated with lower receipt of curative therapy and with poorer survival, current society guidelines provide limited guidance/recommendations addressing HCC surveillance in patients with NAFLD outside the context of established cirrhosis. Limited data are presently available to guide clinicians with respect to which patients with NAFLD should undergo HCC surveillance, optimal screening tools, frequency of monitoring, and the influence of coexisting host- and disease-related risk factors. Herein we present an evidence-based review addressing HCC risk in patients with NAFLD and provide Best Practice Advice statements to address key issues in clinical management.


Cirrhosis; Fibrosis; HCC; NASH

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