Risk Stratification for Hepatocellular Carcinoma in Patients with Non-alcoholic Fatty Liver Disease

Purposeof Review: This review aims to supply up-to-date recommendations on risk stratification for hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). Recent Findings: NAFLD is the most rapidly growing cause of HCC in the USA. HCC surveillance in patients with NAFLD remains a clinical challenge due to the large global burden of NAFLD, limitations in surveillance modalities, and the widely recognized possibility of HCC development in NAFLD in the absence of cirrhosis. Summary: Based on fibrosis staging, HCC screening in NAFLD is recommended in cirrhosis, considered in advanced fibrosis, and not recommended in the absence of advanced fibrosis. Though liver biopsy is the gold standard for staging, evidence of advanced fibrosis warranting HCC surveillance in NAFLD can be based on 2 concordant noninvasive tests. Those meeting recommended criteria for HCC surveillance should undergo imaging with or without serum α-fetoprotein levels every 6 months at minimum.