Clin Mol Hepatol.
2024 Jul;30(3):436-448. 10.3350/cmh.2024.0109.
Global prevalence of metabolic dysfunction-associated fatty liver disease-related hepatocellular carcinoma: A systematic review and meta-analysis
- Crane H1
- Eslick GD2
- Gofton C1,3
- Shaikh A4
- Cholankeril G5
- Cheah M6
- Zhong JH7
- Svegliati-Baroni G8
- Vitale A9
- Kim BK10
- Ahn SH10
- Kim MN10
- Strasser SI11
- George J
1
- Affiliations
-
- 1Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
- 2NHMRC Centre for Research Excellence in Digestive Diseases, Hunter Medical Research Institute (HMRI), The University of Newcastle, Newcastle, NSW, Australia
- 3Department of Gastroenterology, Royal North Shore Hospital, St Leonards, NSW, Australia
- 4Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
- 5Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
- 6Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- 7Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China
- 8Liver Injury and Transplant Unit, Polytechnic University of Marche, Ancona, Italy
- 9Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- 10Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- 11AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, VIC, Australia
- KMID: 2557394
- DOI: http://doi.org/10.3350/cmh.2024.0109
Abstract
- Background/Aims
The global proportion of hepatocellular carcinoma (HCC) attributable to metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. The MAFLD diagnostic criteria allows objective diagnosis in the presence of steatosis plus defined markers of metabolic dysfunction, irrespective of concurrent liver disease. We aimed to determine the total global prevalence of MAFLD in HCC cohorts (total-MAFLD), including the proportion with MAFLD as their sole liver disease (single-MAFLD), and the proportion of those with concurrent liver disease where MAFLD was a contributary factor (mixed-MAFLD).
Methods
This systematic review and meta-analysis included studies systematically ascertaining MAFLD in HCC cohorts, defined using international expert panel criteria including ethnicity-specific BMI cut-offs. A comparison of clinical and tumour characteristics was performed between single-MAFLD, mixed-MAFLD, and non-MAFLD HCC.
Results
22 studies (56,565 individuals with HCC) were included. Total and single-MAFLD HCC prevalence was 48.7% (95% confidence interval [CI] 34.5–63.0%) and 12.4% (95% CI 8.3–17.3%), respectively. In HCC due to chronic hepatitis B, C, and alcohol-related liver disease, mixed-MAFLD prevalence was 40.0% (95% CI 30.2–50.3%), 54.1% (95% CI 40.4–67.6%) and 64.3% (95% CI 52.7–75.0%), respectively. Mixed-MAFLD HCC had significantly higher likelihood of cirrhosis and lower likelihood of metastatic spread compared to single-MAFLD HCC, and a higher platelet count and lower likelihood of macrovascular invasion compared to non-MAFLD HCC.
Conclusions
MAFLD is common as a sole aetiology, but more so as a co-factor in mixed-aetiology HCC, supporting the use of positive diagnostic criteria.
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