[Characteristics and treatment strategies for hepatocellular carcinoma caused by nonalcoholic fatty liver disease].

In recent years, nonalcoholic fatty liver disease (NAFLD) incidence has rapidly increased, and it is gradually becoming a major contributor to liver cirrhosis and hepatocellular cancer (HCC). The degree of liver fibrosis, diabetes mellitus (DM), obesity, age, and gender are the main risk factors for nonalcoholic steatohepatitis (NASH) progression to HCC. Patients with NASH-related HCC are predominantly male, and almost all of them have at least one metabolic disorder (obesity, DM, dyslipidemia, hypertension, etc.). Most HCCs manifest as solitary tumor nodules and a significant number of NASH-related HCCs are non- cirrhotic. Case fatality rates are similar across patients with cirrhotic and noncirrhotic HCC, despite the fact that patients with noncirrhotic HCC tend to be older, have a single macronodular tumor, and have lower incidence of type 2 diabetes and liver transplantation. Controlling the risk factors for NASH might thereby minimize the likelihood of developing HCC. The BCLC staging system should be used as a guide to treat patients with NASH-related HCC. The long-term outcomes of NAFLD-related HCC treatment are similar to those for other HCCs of different etiologies. However, patients combined with metabolic syndrome are at high perioperative risk, so apporpriate preoperative preparation, especially cardiac examination, is essential to avoid this risk.近年来，非酒精性脂肪性肝病（NAFLD）的发病率迅速增长，正逐步成为肝硬化和肝细胞癌（HCC）的主要因素。从非酒精性脂肪性肝炎（NASH）进展到HCC的主要风险因素是肝纤维化程度、糖尿病（DM）、肥胖症、年龄和性别。NASH相关的HCC患者主要为男性，几乎所有患者并发至少一种代谢紊乱（肥胖症、DM、血脂异常、高血压等），且大多数HCC为孤立性肿瘤结节。此外，NASH相关的HCC中有相当一部分无肝硬化。与肝硬化性HCC患者相比，非肝硬化性HCC患者的年龄更大，单个大结节性肿瘤更常见，2型DM患病率和肝移植率较低，但二者的病死率相当。控制NASH的危险因素可以降低HCC的发生风险。NASH相关HCC的患者应按照BCLC分期进行治疗。NAFLD相关HCC治疗的远期结果与其他不同病因的HCC结果相似。但合并代谢综合征的患者围手术期的风险很高，因此需要准确的术前准备，尤其是心脏检查。.