To investigate the clinicopathological features of non-alcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) in a single center.

Clinicopathological data of 10 patients with NAFLD-associated HCC admitted to Department of Hepatobiliary Surgery, Affiliated Hospital of Jiangnan University from January 2020 to October 2024 were retrospectively analyzed. Among them, 7 patients were male and 3 female, aged from 44 to 80 years, with a median age of 71 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Medical history, laboratory examination, imaging features, treatment methods and clinical prognosis were analyzed.

Among 10 patients, 7 cases were diagnosed with liver space-occupying lesions by physical examination, and no evident clinical symptoms were detected. One patient developed the upper abdominal pain accompanied with fever of unknown origin, and two patients had the upper abdominal pain complicated with jaundice of unknown origin. All 10 patients had a history of fatty liver disease, neither hepatitis B, hepatitis C nor excessive drinking, including 1 case of mild fatty liver disease, 4 moderate fatty liver disease and 5 severe fatty liver disease, respectively. Four patients were complicated with elevated AFP, highest up to 3 000 μg/L. Among them, 4 patients were diagnosed with hypertension, 2 cases of hypertension complicated with diabetes mellitus, 1 case of hypertension complicated with cerebral infarction. Preoperative imaging revealed two patients were diagnosed with hepatic hemangioma, and 2 cases of atypical benign tumors. All 7 patients underwent laparoscopic radical resection of HCC. Postoperative pathological examination showed 1 case of well-differentiated HCC, 2 moderately-and well-differentiated HCC, 3 moderately-differentiated HCC, 1 moderately-and poorly-differentiated HCC and 3 poorly-differentiated HCC, respectively. One case experienced postoperative bile leakage, and the remaining patients were recovered. The length of hospital stay was (14±4) d. Follow-up endured for 3 months to 2 years. Only 1 patient recurred.

NAFLD-associated HCC patients are primarily complicated with fatty liver disease. For NAFLD patients complicated with liver masses, the possibility of liver cancer should be considered. Intimate observation and regular reexamination are needed. Prompt surgical treatment should be performed upon diagnosis.