**4. Pathogenesis of NAFLD associated HCC**

NAFLD associated HCC is similar to many chronic liver disease related hepatocellular carcinomas, where hepatocellular injury and subsequent necroinflammation drive the formation of a protumorigenic microenvironment in the liver [31–33]. This microenvironment consists of a complex chronic inflammatory state with increased metabolic, oxidative, and mutagenic cellular stress, ultimately driving hepatocarcinogenesis (**Figure 1**) [31, 34, 35]. Different from other causes of HCC, e.g., viral or alcohol, an altered metabolomic state is the driver of hepatocellular injury in NAFLD associated HCC, playing an important role throughout the pathogenic process, and culminating in unique alterations of the molecular phenotype of the resulting tumor. The precise pathogenic mechanisms of NAFLD associated HCC continue to evolve, as the complex interplay of environmental factors, genetic susceptibility, and intricate inflammatory conditions further unfold.
