4. Conclusions

Although significant progress has been made in NAFLD/NASH related HCC, many issues still remain to be resolved. With the prevalence of HCV declining in the last years, the incidence of NAFLD/NASH is expected to account for a greater proportion of HCC incidence in the near future due to the growing epidemic of obesity, diabetes and metabolic syndrome, known as independent metabolic risk factors for development of HCC. The annual incidence rate of HCC developed in patients with NASH-related cirrhosis is not yet clearly established and recent evidence show that a significant number of patients with NAFLD or NASH progress to HCC in the absence of hepatic cirrhosis. NAFLD/NASH-related cirrhotic patients receive significantly less surveillance for HCC than those with HCV-related cirrhosis, in contrast to epidemiological data and this represents an important public health problem. Also dysbiosis play an important role in progression of liver disease via changes in bile acids metabolism and dysregulation of intestinal barrier.

In conclusion, metabolic syndrome comprising of obesity, type 2 diabetes, dyslipidemia, hypertension, is related with an increased risk for development of HCC. NAFLD considered the liver manifestation of metabolic syndrome is an important factor implicated in progression to HCC. Also alteration in gut microbiota seems to be connected with HCC occurrence but many questions still remain to be answered.
