Nonalcoholic steatohepatitis and hepatocellular carcinoma: Brazilian survey


  • Helma P. Cotrim Universidade Federal da Bahia; Departamento de Medicina - Serviço de Gastro-Hepatologia
  • Claudia P. Oliveira Universidade de São Paulo; Departamento de Gastroenterologia
  • Henrique Sérgio M. Coelho Universidade Federal do Rio de Janeiro; Departamento de Clínica Médica
  • Mario R. Alvares-da-Silva Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre; Departamento de Medicina Interna; Serviço de Gastroenterologia
  • Leticia Nabuco Setor de Hepatologia; Serviço de Clinica Médica; Hospital Federal dos Servidores do Estado
  • Edison Roberto Parise Universidade de São Paulo; Departamento de Gastroenterologia
  • Claúdia Ivantes Hepatologia e Transplante Hepático; Hospital Nossa Senhora das Graças. Serviço de Gastroenterologia
  • Ana LC Martinelli Universidade de São Paulo; Faculdade de Medicina de Ribeirao Preto; Divisao de Gastroenterologia; Departamento de Clinica Medica
  • João Galizzi-Filho Universidade Federal de Minas Gerais; Departamento de Clínica Médica
  • Flair J. Carrilho Sociedade Brasileira de Hepatologia (SBH); Members of the NAFLD - HCC Survey



OBJECTIVE: The majority of cases of hepatocellular carcinoma have been reported in individuals with cirrhosis due to chronic viral hepatitis and alcoholism, but recently, the prevalence has become increasingly related to nonalcoholic steatohepatitis around the world. The study aimed to evaluate the clinical and histophatological characteristics of hepatocellular carcinoma in Brazilians' patients with nonalcoholic steatohepatitis at the present time. METHODS: Members of the Brazilian Society of Hepatology were invited to complete a survey regarding patients with hepatocellular carcinoma related to nonalcoholic steatohepatitis. Patients with a history of alcohol intake (>;20 g/day) and other liver diseases were excluded. Hepatocellular carcinoma diagnosis was performed by liver biopsy or imaging methods according to the American Association for the Study of Liver Diseases’ 2011 guidelines. RESULTS: The survey included 110 patients with a diagnosis of hepatocellular carcinoma and nonalcoholic fatty liver disease from nine hepatology units in six Brazilian states (Bahia, Minas Gerais, Rio de Janeiro, São Paulo, Paraná and Rio Grande do Sul). The mean age was 67±11 years old, and 65.5% were male. Obesity was observed in 52.7% of the cases; diabetes, in 73.6%; dyslipidemia, in 41.0%; arterial hypertension, in 60%; and metabolic syndrome, in 57.2%. Steatohepatitis without fibrosis was observed in 3.8% of cases; steatohepatitis with fibrosis (grades 1-3), in 27%; and cirrhosis, in 61.5%. Histological diagnosis of hepatocellular carcinoma was performed in 47.2% of the patients, with hepatocellular carcinoma without cirrhosis accounting for 7.7%. In total, 58 patients with cirrhosis had their diagnosis by ultrasound confirmed by computed tomography or magnetic resonance imaging. Of these, 55% had 1 nodule; 17%, 2 nodules; and 28%, ≥3 nodules. CONCLUSIONS: Nonalcoholic steatohepatitis is a relevant risk factor associated with hepatocellular carcinoma in patients with and without cirrhosis in Brazil. In this survey, hepatocellular carcinoma was observed in elevated numbers of patients with steatohepatitis without cirrhosis.


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How to Cite

Cotrim, H. P., Oliveira, C. P., Coelho, H. S. M., Alvares-da-Silva, M. R., Nabuco, L., Parise, E. R., Ivantes, C., Martinelli, A. L., Galizzi-Filho, J., & Carrilho, F. J. (2016). Nonalcoholic steatohepatitis and hepatocellular carcinoma: Brazilian survey . Clinics, 71(5), 281-284.



Clinical Sciences