Expert Review of Gastroenterology & Hepatology, 2015
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Wes... more Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries and is also predicted to become the most frequent indication for liver transplantation by 2030. In the last decade, it has become evident that the clinical burden of NAFLD is not restricted to liver-related morbidity or mortality, but there is now compelling evidence that NAFLD is a multisystem disease, affecting many extra-hepatic organs. In this article, we discuss the evidence linking NAFLD with important cardiometabolic complications (mainly Type 2 diabetes and cardiovascular disease) and the putative underlying mechanisms by which NAFLD may contribute to the development of these complications.
Gut microbiota has been recently established to have a contributory role in the development of ca... more Gut microbiota has been recently established to have a contributory role in the development of cardiometabolic disorders, such as atherosclerosis, obesity, and type 2 diabetes. Growing interest has focused on the modulation of gut microbiota as a therapeutic strategy in cardiovascular diseases and metabolic disorders. In this paper, we have reviewed the impact of gut microbiota on metabolic disorders and cardiovascular disease risk, focusing on the newest findings in this field.
An improved understanding of non-alcoholic fatty liver disease epidemiology would lead to identif... more An improved understanding of non-alcoholic fatty liver disease epidemiology would lead to identification of individuals at high risk of developing chronic liver disease and extra-hepatic complications, thus contributing to more effective case finding of non-alcoholic fatty liver disease among selected groups. We aimed to illustrate the epidemiology of non-alcoholic fatty liver disease in high-risk groups, which were identified based on existing literature. To this end, PubMed was searched to retrieve original articles published until May 2015 using relevant and pertinent keywords "nonalcoholic fatty liver disease" and "diabetes", "obesity", "hyperlipidaemia", "familial heterozygous hypobetalipoproteinaemia",…
Contrasting data exist on the effect of gender and menopause on the susceptibility, development a... more Contrasting data exist on the effect of gender and menopause on the susceptibility, development and liver damage progression in non alcoholic fatty liver disease (NAFLD). Our aim was to assess whether menopause is associated with severity of liver fibrosis in patients with NAFLD and to explore the issue of ovarian senescence in experimental liver steatosis in zebrafish.In 244 females and age-matched males with biopsy-proven NAFLD we assessed anthropometric, biochemical, and metabolic features, including menopausal status (self-reported); liver biopsy was scored according to "The Pathology Committee of the NASH Clinical Research Network". Young and old male and female zebrafish were fed for 24 weeks with a high-calories diet. Weekly BMI, histopathological examination, quantitative RT-PCR on genes involved in lipid metabolism, inflammation and fibrosis were performed.In the entire cohort, at multivariate logistic regression, male gender (OR: 1.408, CI: 0.779-2.542, p=0.25) vs. women at reproductive age was not associated with F2-F4 fibrosis, while a trend was observed for menopause (OR: 1.752, 95%CI: 0.956-3.208, p=0.06). In women, menopause (OR: 2.717, 95%CI: 1.020-7.237, p=0.04) was independently associated with F2-F4 fibrosis. Similarly, in overfed zebrafish, old female fish with failing ovarian function [as demonstrated by extremely low circulating estradiol levels (1.4±0.1 pg/μl) and prevailing presence of atretic follicles in the ovaries)] developed massive steatosis and substantial fibrosis (comparable with that occurring in males) while young female fish developed less steatosis and were totally protected from development of fibrosis.Ovarian senescence significantly increases the risk of fibrosis severity both in humans with NAFLD and in zebrafish with experimental steatosis.
Introduction. Metabolic conditions, including type 2 diabetes, have been related to hepatocellula... more Introduction. Metabolic conditions, including type 2 diabetes, have been related to hepatocellular carcinoma (HCC) risk. We have further analyzed the role of diabetes and antidiabetic treatments on HCC. Methods. Data derived from a hospital-based case-control study (Italy, 2005(Italy, -2012 on 224 HCC patients and 389 controls. Odds ratios (ORs) were estimated using multiple logistic regression models. Results. Sixty-nine (30.9%) cases versus 52 (13.5%) controls reported a diabetes diagnosis, corresponding to a multivariate OR of 2.25 (95% confidence interval, CI = 1.42-3.56). A stronger excess risk emerged for a longer time since diabetes diagnosis (OR = 2.96 for <10 years and 5.33 for ≥10 years). Oral therapies were inversely, though not significantly, related to HCC risk, OR being 0.44 for metformin and 0.88 for sulfonylureas; conversely, insulin was nonsignificantly directly associated (OR = 1.90). Compared to nondiabetic subjects who were never smokers, those who were diabetics and ever smokers had an OR of 6.61 (95% CI 3.31-13.25). Conclusion. Our study confirms an over 2-fold excess HCC risk in diabetics, with a stronger excess risk in diabetic subjects who are also tobacco smokers. Metformin may decrease the risk of HCC, whereas insulin may increase the risk.
Background: Hematopoietic stem cell transplantation is increasingly performed for hematologic dis... more Background: Hematopoietic stem cell transplantation is increasingly performed for hematologic diseases. As a major side effect, acute graft versus host disease (GvHD) with serious gastrointestinal symptoms including diarrhea, gastrointestinal bleeding and high mortality can be observed. Because surveillance and biopsies of human gastrointestinal GvHD are difficult to perform, rare information of the alterations of the gastrointestinal barrier exists resulting in a need for systematic animal models. Methods: To investigate the effects of GvHD on the intestinal barrier of the small intestine we utilized an established acute semi allogenic GvHD in C57BL/6 and B6D2F1 mice.
Veno-occlusive disease (VOD) of the liver is a severe complication of high-dose chemotherapy and ... more Veno-occlusive disease (VOD) of the liver is a severe complication of high-dose chemotherapy and allogeneic or autologous stem cell transplantation with potential fatal outcome. We report a case of severe VOD in a patient with a high-grade B-cell lymphoma. Liver-venule occlusion was confirmed by liver biopsy. Supportive care, fibrinolytic treatment with recombinant tissue plasminogen activator and defibrotide maintenance therapy led to complete resolution of VOD demonstrated at liver biopsy and with a follow-up of 44 months after autologous peripheral blood stem cell transplantation. The literature on VOD has been reviewed.
Background/Aims: While chemokines appear to be important in certain inflammatory disorders, littl... more Background/Aims: While chemokines appear to be important in certain inflammatory disorders, little is known about the role of these proteins in chronic hepatitis C. Methods: Expression of selected CXC and CC chemokines and their receptors was assessed by immunohistochemistry and flow cytometry in chronic hepatitis C. Tissue samples from normal liver and sustained responders were also evaluated. A comparative analysis between the histologic grading and the intrahepatic expression level of chemokines was performed. Results: The majority of liver-derived T lymphocytes expressed CXCR3 and CCR5 chemokine receptors, representing high enrichment over levels of CXCR3+ and CCR5+ T cells in blood from chronic hepatitis C. An intense intrahepatic expression of their respective ligands, Mig and RANTES, was detected in the same patients studied, being restricted to the sinusoidal endothelium and to hepatocytes, respectively. A statistically significant association between the intrahepatic chemokine expression level and the inflammatory activity of chronic hepatitis C was found. Noteworthy, the marked expression of both CXCR3 and its ligand Mig on endothelial cells from portal neovessels in chronic hepatitis C.
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndr... more Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolte to hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. Aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC), and to compare them to those of HCV-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in Secondary Care Italian Centers. Survival was modeled according to clinical parameters, lead time bias and propensity analysis. As compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC, differently from the near totality of HCV-HCC. Regardless of the tumor stage, the survival was significantly shorter (p=0.017) in patients with NAFLD-HCC, namely 25.5 months (95% CI 21.9-29.1) than with HCV-HCC, 33.7 months (95% CI 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, the analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively 38.6 vs 41.0 months, p=n.s.) Conclusions: NAFLD-HCC and is more often detected at a later tumor stage and could arise also in the absence of cirrhosis. However after patient matching, NAFLD-HCC has a similar survival as compared to HCV-infected patients. Future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. This article is protected by copyright. All rights reserved.
Expert Review of Gastroenterology & Hepatology, 2015
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Wes... more Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries and is also predicted to become the most frequent indication for liver transplantation by 2030. In the last decade, it has become evident that the clinical burden of NAFLD is not restricted to liver-related morbidity or mortality, but there is now compelling evidence that NAFLD is a multisystem disease, affecting many extra-hepatic organs. In this article, we discuss the evidence linking NAFLD with important cardiometabolic complications (mainly Type 2 diabetes and cardiovascular disease) and the putative underlying mechanisms by which NAFLD may contribute to the development of these complications.
Gut microbiota has been recently established to have a contributory role in the development of ca... more Gut microbiota has been recently established to have a contributory role in the development of cardiometabolic disorders, such as atherosclerosis, obesity, and type 2 diabetes. Growing interest has focused on the modulation of gut microbiota as a therapeutic strategy in cardiovascular diseases and metabolic disorders. In this paper, we have reviewed the impact of gut microbiota on metabolic disorders and cardiovascular disease risk, focusing on the newest findings in this field.
An improved understanding of non-alcoholic fatty liver disease epidemiology would lead to identif... more An improved understanding of non-alcoholic fatty liver disease epidemiology would lead to identification of individuals at high risk of developing chronic liver disease and extra-hepatic complications, thus contributing to more effective case finding of non-alcoholic fatty liver disease among selected groups. We aimed to illustrate the epidemiology of non-alcoholic fatty liver disease in high-risk groups, which were identified based on existing literature. To this end, PubMed was searched to retrieve original articles published until May 2015 using relevant and pertinent keywords &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;nonalcoholic fatty liver disease&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;diabetes&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;obesity&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;hyperlipidaemia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;familial heterozygous hypobetalipoproteinaemia&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;,…
Contrasting data exist on the effect of gender and menopause on the susceptibility, development a... more Contrasting data exist on the effect of gender and menopause on the susceptibility, development and liver damage progression in non alcoholic fatty liver disease (NAFLD). Our aim was to assess whether menopause is associated with severity of liver fibrosis in patients with NAFLD and to explore the issue of ovarian senescence in experimental liver steatosis in zebrafish.In 244 females and age-matched males with biopsy-proven NAFLD we assessed anthropometric, biochemical, and metabolic features, including menopausal status (self-reported); liver biopsy was scored according to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;The Pathology Committee of the NASH Clinical Research Network&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Young and old male and female zebrafish were fed for 24 weeks with a high-calories diet. Weekly BMI, histopathological examination, quantitative RT-PCR on genes involved in lipid metabolism, inflammation and fibrosis were performed.In the entire cohort, at multivariate logistic regression, male gender (OR: 1.408, CI: 0.779-2.542, p=0.25) vs. women at reproductive age was not associated with F2-F4 fibrosis, while a trend was observed for menopause (OR: 1.752, 95%CI: 0.956-3.208, p=0.06). In women, menopause (OR: 2.717, 95%CI: 1.020-7.237, p=0.04) was independently associated with F2-F4 fibrosis. Similarly, in overfed zebrafish, old female fish with failing ovarian function [as demonstrated by extremely low circulating estradiol levels (1.4±0.1 pg/μl) and prevailing presence of atretic follicles in the ovaries)] developed massive steatosis and substantial fibrosis (comparable with that occurring in males) while young female fish developed less steatosis and were totally protected from development of fibrosis.Ovarian senescence significantly increases the risk of fibrosis severity both in humans with NAFLD and in zebrafish with experimental steatosis.
Introduction. Metabolic conditions, including type 2 diabetes, have been related to hepatocellula... more Introduction. Metabolic conditions, including type 2 diabetes, have been related to hepatocellular carcinoma (HCC) risk. We have further analyzed the role of diabetes and antidiabetic treatments on HCC. Methods. Data derived from a hospital-based case-control study (Italy, 2005(Italy, -2012 on 224 HCC patients and 389 controls. Odds ratios (ORs) were estimated using multiple logistic regression models. Results. Sixty-nine (30.9%) cases versus 52 (13.5%) controls reported a diabetes diagnosis, corresponding to a multivariate OR of 2.25 (95% confidence interval, CI = 1.42-3.56). A stronger excess risk emerged for a longer time since diabetes diagnosis (OR = 2.96 for <10 years and 5.33 for ≥10 years). Oral therapies were inversely, though not significantly, related to HCC risk, OR being 0.44 for metformin and 0.88 for sulfonylureas; conversely, insulin was nonsignificantly directly associated (OR = 1.90). Compared to nondiabetic subjects who were never smokers, those who were diabetics and ever smokers had an OR of 6.61 (95% CI 3.31-13.25). Conclusion. Our study confirms an over 2-fold excess HCC risk in diabetics, with a stronger excess risk in diabetic subjects who are also tobacco smokers. Metformin may decrease the risk of HCC, whereas insulin may increase the risk.
Background: Hematopoietic stem cell transplantation is increasingly performed for hematologic dis... more Background: Hematopoietic stem cell transplantation is increasingly performed for hematologic diseases. As a major side effect, acute graft versus host disease (GvHD) with serious gastrointestinal symptoms including diarrhea, gastrointestinal bleeding and high mortality can be observed. Because surveillance and biopsies of human gastrointestinal GvHD are difficult to perform, rare information of the alterations of the gastrointestinal barrier exists resulting in a need for systematic animal models. Methods: To investigate the effects of GvHD on the intestinal barrier of the small intestine we utilized an established acute semi allogenic GvHD in C57BL/6 and B6D2F1 mice.
Veno-occlusive disease (VOD) of the liver is a severe complication of high-dose chemotherapy and ... more Veno-occlusive disease (VOD) of the liver is a severe complication of high-dose chemotherapy and allogeneic or autologous stem cell transplantation with potential fatal outcome. We report a case of severe VOD in a patient with a high-grade B-cell lymphoma. Liver-venule occlusion was confirmed by liver biopsy. Supportive care, fibrinolytic treatment with recombinant tissue plasminogen activator and defibrotide maintenance therapy led to complete resolution of VOD demonstrated at liver biopsy and with a follow-up of 44 months after autologous peripheral blood stem cell transplantation. The literature on VOD has been reviewed.
Background/Aims: While chemokines appear to be important in certain inflammatory disorders, littl... more Background/Aims: While chemokines appear to be important in certain inflammatory disorders, little is known about the role of these proteins in chronic hepatitis C. Methods: Expression of selected CXC and CC chemokines and their receptors was assessed by immunohistochemistry and flow cytometry in chronic hepatitis C. Tissue samples from normal liver and sustained responders were also evaluated. A comparative analysis between the histologic grading and the intrahepatic expression level of chemokines was performed. Results: The majority of liver-derived T lymphocytes expressed CXCR3 and CCR5 chemokine receptors, representing high enrichment over levels of CXCR3+ and CCR5+ T cells in blood from chronic hepatitis C. An intense intrahepatic expression of their respective ligands, Mig and RANTES, was detected in the same patients studied, being restricted to the sinusoidal endothelium and to hepatocytes, respectively. A statistically significant association between the intrahepatic chemokine expression level and the inflammatory activity of chronic hepatitis C was found. Noteworthy, the marked expression of both CXCR3 and its ligand Mig on endothelial cells from portal neovessels in chronic hepatitis C.
Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndr... more Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of metabolic syndrome and may evolte to hepatocellular carcinoma (HCC). Only scanty clinical information is available on HCC in NAFLD. Aim of this multicenter observational prospective study was to assess the clinical features of patients with NAFLD-related HCC (NAFLD-HCC), and to compare them to those of HCV-related HCC. A total of 756 patients with either NAFLD (145) or HCV-related chronic liver disease (611) were enrolled in Secondary Care Italian Centers. Survival was modeled according to clinical parameters, lead time bias and propensity analysis. As compared to HCV, HCC in NAFLD patients had a larger volume, showed more often an infiltrative pattern and was detected outside specific surveillance. Cirrhosis was present in only about 50% of NAFLD-HCC, differently from the near totality of HCV-HCC. Regardless of the tumor stage, the survival was significantly shorter (p=0.017) in patients with NAFLD-HCC, namely 25.5 months (95% CI 21.9-29.1) than with HCV-HCC, 33.7 months (95% CI 31.9-35.4). To eliminate possible confounders, a propensity score analysis was performed, which showed no more significant difference between the two groups. Additionally, the analysis of patients within Milan criteria submitted to curative treatments did not show any difference in survival between NAFLD-HCC and HCV-HCC (respectively 38.6 vs 41.0 months, p=n.s.) Conclusions: NAFLD-HCC and is more often detected at a later tumor stage and could arise also in the absence of cirrhosis. However after patient matching, NAFLD-HCC has a similar survival as compared to HCV-infected patients. Future challenge will be to identify patients with NAFLD who require more stringent surveillance in order to offer the most timely and effective treatment. This article is protected by copyright. All rights reserved.
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