Background and Methods
Hepatocellular carcinoma (HCC) is one of the most lethal cancers, and affects many of the world's populations. Various etiologies have been linked to HCC development, the most prominent of which include hemochromatosis, chronic viral hepatitis due to either B or C infection, excess alcohol consumption and aflatoxin-B1-contaminated food. Virtually all cirrhosis-inducing conditions can cause HCC, pointing to important interactions with the host micro-environment. Moreover, the number of multifocal disease stemming from non-cirrhotic disease may be expected to increase as a result of the "explosion" of nonalcoholic fatty liver disease (NAFLD) worldwide and of failure to offer surveillance to patients with clinically occult chronic liver disease developed in the setting of the metabolic syndrome.
The presently available therapeutic weaponry, which includes radical and palliative options, is not applicable to all patients. Therapeutic failures may result from diagnostic delays, particularly in those with underlying non-cirrhotic liver disease, or recurrent HCC in those with poor liver function. In clinical practice, little is usually done for the secondary chemoprevention of disease in those who, already treated for HCC, remain susceptible to disease recurrence elsewhere in their cirrhotic livers.
Based on the observation that the growth of HCC growth critically depends on cholesterol, we discuss the evidence potentially favoring the use of statins in clinical trials aimed at primary and secondary chemoprevention of HCC in those individuals at high risk of developing this condition and slowing the course of otherwise incurable primary or recurrent disease.
A Medline search of the literature conducted on 12 June 2012, (key words: Statins; hepatocellular carcinoma) provided 119 references. Such references, which were all evaluated for potential inclusion, cross-references, and all those references deemed to be relevant by the authors represent the basis of the present review.
J Gastroenterol Hepatol. 2012;27(11):1654-1664. © 2012 Blackwell Publishing