Metabolic syndrome and hepatocellular carcinoma

Two growing epidemics with a potential link


  • Abby B. Siegel MD, MS,

    Corresponding author
    1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
    2. Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
    • Department of Medicine, Columbia University College of Physicians and Surgeons, Columbia University, 622 West 168th Street, PH-14, New York, NY 10032-3784===

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    • Fax: (212) 305-4343

  • Andrew X. Zhu MD, PhD

    1. Tucker Gosnell Center for Gastrointestinal Cancers, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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Hepatocellular carcinoma (HCC) is the most rapidly increasing cause of cancer death in the United States. Although many risk factors for HCC are well defined, including hepatitis B virus (HBV), hepatitis C virus (HCV), and alcohol, most series have indicated that 5% to 30% of patients with HCC lack a readily identifiable risk factor for their cancer. The majority of “cryptogenic” HCC in the United States is attributed to nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome. The metabolic syndrome is a constellation of problems that includes insulin resistance, obesity, hypertension, and hyperlipidemia. Increasingly, components of the metabolic syndrome are being linked to various forms of cancer with respect to both increased risk of disease and worsened outcome. In this review, the authors focused on the relation between metabolic syndrome and HCC. They investigated the increased risks of HCC among individuals with features of metabolic syndrome, potentially worsened cancer outcomes in these patients, possible pathogenic mechanisms to explain these relations, and treatment options for those with NAFLD and its progressive counterpart, nonalcoholic steatohepatitis. It is predicted that metabolic syndrome will lead to large increases in the incidence of HCC over the next decades. A better understanding of the relation between these 2 diseases ultimately should lead to improved screening and treatment options for patients with HCC. Cancer 2009. © 2009 American Cancer Society.