As the prevalence of lifestyle-related diseases increases, the number of individuals who have abnormal liver function test results with negative HBs
antigen and anti-HCV(non-B non-C
liver diseases) has been increasing. Non-B non-C
liver diseases consist mainly of
nonalcoholic fatty liver disease (
NAFLD) and al- coholic
liver disease. Non-B non-C
liver cancers have been increasing in number. The identification of individuals with high risks of
liver cancer is crucial for their early diagnosis and treatment. Among
NAFLD individuals,
nonalcoholic steatohepatitis (NASH) patients with advanced
liver fibrosis have a high risk of non-B non-C
liver cancers. For the diagnosis of NASH with advanced
liver fibrosis, useful parameters are as follows: 1) high value of
liver fibrosis markers, such as type 4
collagen 7S, 2) low platelet count (lower than 19 X 104/pL), 3) high value using a scoring system, such as the
NAFLD fibrosis score and FIB-4 index, 4) high stiffness value measured by elastography, 5) advanced age, and 6) comorbidity of 3 or 4 types of lifestyle-related diseases. Alcohol drinkers consuming more than 60 g of
ethanol a day are at risk of
liver cancer.
Obesity and
diabetes mellitus are also risk factors. Individuals as described above are at risk of non-B non-C
liver cancers. AFP is unlikely to show a high value in NASH
liver cancer. Regular examination (every 6 months) with sonography and
PIVKA-II is rec- ommended for the early diagnosis of non-B non-C
liver cancers.