Hepatocellular carcinoma: Where are we?

Table 1 Identified risk factors for hepatocellular carcinoma

Age

Ethnicity

Male Gender

Liver cirrhosis

Chronic HBV infection

Chronic HCV infection

Hemochromatosis

Alcoholism

Aflatoxin-B1 intoxication

Tyrosinemia, galactosidemia, fructosemia

Alpha1 anti-trypsin deficiency

Genetics predisposition

Anabolizing hormones

Estrogen contraceptives

Obesity

Type II diabetes

Glucose overload

Metabolic syndrome

Hypothyroidism

Fatty liver

Non-alcoholic steato-hepatitis

HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Protective or probably protective factors

HBV vaccination

Physical exercise

Balanced diet

High vegetable consumption

Calcium

Vitamin D

Coffee

HBV: Hepatitis B virus.

Table 3 Patients where surveillance program is suggested by International Societies for the Study of the Liver (AASLD, EASL-EORTC, JSH, APASL)

Society	Target population	Target population
APASL, 2010	Chronic hepatitis	Cirrhosis
	No recommendation	HBV and HCV cirrhosis
AASLD, 2011	HBV-positive patients	HBV and/or HCV cirrhotics
	Male Asian HBV+ > 40 yr	Fourth stage PBC
	African > 20 yr; Familial predisposition + for HCC	a1-antitrypsin deficit
		Autoimmune hepatitis
		NASH
JSH, 2011	HBV and HCV chronic hepatitis	Non viral cirrhosis
		HBV and HCV cirrhosis
EASL, 2012	HBV + active hepatitis	Child A and B cirrhosis
	HCV + hepatitis with advanced fibrosis F3 (Metavir)	Child C cirrhosis with indication to liver transplantation

AASLD: American Association for the Study of Liver Diseases; JSH: Japan Society of Hepatology; EASL: European Association for the Study of the Liver; APASL: Asian Pacific Association for the Study of the Liver; NASH: Non-alcoholic steato-hepatitis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; PBC: Primary biliary cirrhosis; EORTC: European Organization for Research and Treatment of Cancer.