Clin Mol Hepatol.
2024 Jul;30(3):487-499. 10.3350/cmh.2024.0145.
Evolutionary changes in metabolic dysfunction-associated steatotic liver disease and risk of hepatocellular carcinoma: A nationwide cohort study
- Jeong S1,2
- Oh YH3
- Ahn JC4
- Choi S5
- Park SJ2
- Kim HJ2
- Lee G6
- Son JS7
- Jang H8
- Lee DH8
- Sha M9
- Chen L10,11
- Kim W
8,12 - Park SM2,6
- Affiliations
-
- 1Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Korea
- 2Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- 3Department of Family Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
- 4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- 5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 6Department of Family Medicine, Life Clinic, Seoul, Korea
- 7Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
- 8Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- 9Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- 10The International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
- 11National Center for Liver Cancer, Shanghai, China
- 12Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- KMID: 2557397
- DOI: http://doi.org/10.3350/cmh.2024.0145
Abstract
- Background/Aims
To determine the association between evolutionary changes in metabolic dysfunction-associated steatotic liver disease (MASLD) status and the risk of hepatocellular carcinoma (HCC) in a nationwide population-based cohort.
Methods
Information on study participants was derived from the Korea National Health Insurance Service database. The study population consisted of 5,080,410 participants who underwent two consecutive biennial health screenings between 2009 and 2012. All participants were followed up until HCC, death, or 31 December 2020. The association of evolutionary changes in MASLD status, as assessed by the fatty liver index and cardiometabolic risk factors, including persistent non-MASLD, resolved MASLD, incident MASLD, and persistent MASLD, with HCC risk was evaluated using multivariable-adjusted Cox proportional hazards regression.
Results
Among the 5,080,410 participants with 39,910,331 person-years of follow-up, 4,801 participants developed HCC. The incidence of HCC in participants with resolved, incident, and persistent MASLD was approximately 2.2-, 2.3-, and 4.7-fold higher, respectively, than that in those with persistent non-MASLD among the Korean adult population. When stratifying the participants according to the evolutionary change in MASLD status, persistent (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 2.68–3.21; P<0.001), incident (aHR, 1.85; 95% CI, 1.63–2.10; P<0.001), and resolved MASLD (aHR, 1.33; 95% CI, 1.18–1.50; P<0.001) had an increased risk of HCC compared to persistent non-MASLD.
Conclusions
The evolutionary changes in MASLD were associated with the differential risk of HCC independent of metabolic risk factors and concomitant medications, providing additional information on the risk of HCC stratification in patients with MASLD.
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