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| 1 | Hepatocellular carcinoma in non-alcoholic fatty liver disease-a review of an emerging challenge facing clinicians显示文摘Importance:Non-alcoholic fatty liver disease(NAFLD)is a rapidly growing cause of chronic liver disease and is becoming a leading cause of hepatocellular carcinoma(HCC)in many developed countries.This presents major challenges for the surveillance,diagnosis and treatment of HCC.Objective:To discuss the clinical challenges faced by clinicians in managing the rising number of NAFLD-HCC cases.Evidence Review:MEDLINE,PubMed and Embase databases were searched using the keywords;NAFLD,HCC,surveillance,hepatectomy,liver transplantation,percutaneous ablation,transarterial chemoembolization(TACE),selective internal radiotherapy treatment(SIRT)and sorafenib.Relevant clinical studies were included.Findings:Current HCC surveillance programmes are inadequate because they only screen for HCC in patients with cirrhosis,whereas in NAFLD a significant proportion of HCC develops in the absence of cirrhosis.Consequently NAFLD patients often present with a more advanced stage of HCC,with a poorer prognosis.NAFLD-HCC patients also tend to be older and to have more co-morbidities compared to HCC of other etiologies.This limits the use of curative treatments such as liver resection and orthotopic liver transplantation(OLT).Evidence suggests that although NAFLD-HCC patients who undergo liver resection or OLT have worse perioperative and short-term outcomes,overall long-term survival is comparable to HCC of other etiologies.This highlights the importance of careful patient selection,pre-habilitation and perioperative planning for NAFLD-HCC patients being considered for surgical treatment.Careful consideration is also important for non-surgical treatments,although the evidence supporting treatment selection is frequently lacking,as these patients tend to be poorly represented in clinical trials.Locoregional therapies such as percutaneous ablation and TACE may be less well tolerated and less effective in NAFLD patients with obesity or diabetes.The tyrosine kinase inhibitor sorafenib may also be less effective.Conclusions and Relevance:This review highlights how international guidelines,for which NAFLD traditionally has made up a small part of the evidence base,may not be appropriate for all NAFLD-HCC patients.Future guidelines need to reflect the changing landscape of HCC,by making specific recommendations for the management of NAFLD-HCC. | Daniel Geh Derek M.Manas Helen L.Reeves | 2021 | Hepatobiliary Surgery and Nutrition2021，10，1： | 6 |
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| 4 | Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer显示文摘 | Geh JI Crellin AM Glynne-Jones R | | 0，，： | 1 |
| 5 | Fungal endocarditis in a paediatric burns patient 显示文摘 | Geh JL Dziewulski P Teare L | 2001 | Bums2001，27，6： | 1 |
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| 15 | Neuromuscular effects of four phospholipases A2 from the venom of Pseudechis australis, the australian king brown snake显示文摘 | Geh S L Rowan E G Harvey A L | 1992 | Toxicon1992，30，： | 1 |
| 16 | Preoprative ECF chemotherapy in gastro oesophageal adenocarcinoma 显示文摘 | Geh JI Glynne-Jones R Kwok QS | 2000 | Clin Oncol2000，12，3： | 1 |
| 17 | The genetic epidemiology of prostate cancer and its clinical implications 显示文摘 | Eeles R Geh C Castro E | 2014 | Nat Rev Urol2014，11，1： | 1 |
| 18 | Cellular uptake and cyto-toxic potential of respirable bentonite particles with different quartz contents and chemical modifications in human lung fibroblasts 显示文摘 | Stefan Geh Raif Yucel Rodger Duffin | 2006 | Ar-chives of Toxicology2006，80，2： | 1 |
| 19 | Epidemic hand,foot and mouth disease caused by human enteroviras 71,Singapore显示文摘 | Chan KP Geh KT Chong CY | 2003 | Emerg Infect Dis2003，9，1： | 1 |
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