Liver Cancer Risk Across Metabolic Dysfunction-Associated... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ARTICLE: LIVER

Liver Cancer Risk Across Metabolic Dysfunction-Associated Steatotic Liver Disease and/or Alcohol: A Nationwide Study

Yun, Byungyoon MD, PhD1,2,3; Park, Heejoo BSc4; Ahn, Sang Hoon MD, PhD5,6,7; Oh, Juyeon MPH4; Kim, Beom Kyung MD, PhD5,6,7,*; Yoon, Jin-Ha MD, PhD1,2,3,*

1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;

2The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea;

3Institute for Innovation in Digital Healthcare, Yonsei University Health System, Seoul, Republic of Korea;

4Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea;

5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea;

6Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea;

7Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.

Correspondence: Beom Kyung Kim, MD, PhD. E-mail: [email protected]. Jin-Ha Yoon, MD, PhD. E-mail: [email protected].

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/D321, https://links.lww.com/AJG/D322

*Jin-Ha Yoon and Beom Kyung Kim equally contributed to this work as co-corresponding authors.

The American Journal of Gastroenterology ():10.14309/ajg.0000000000002920, June 27, 2024. | DOI: 10.14309/ajg.0000000000002920

Abstract

INTRODUCTION:

New terminologies of metabolic dysfunction-associated steatotic liver disease (MASLD) have been developed. We assessed hepatocellular carcinoma (HCC) risk across MASLD and/or alcohol intake.

METHODS:

We included participants aged 40–79 years receiving a national health checkup from 2009 to 2010 in the Republic of Korea, classified as follows: non-MASLD, MASLD, MASLD with increased alcohol intake (MetALD; weekly alcohol 210–420 g for male and 140–350 g for female individuals), and alcohol-associated liver disease (ALD; excessive alcohol intake with weekly alcohol ≥420 g for male or ≥350 g for female individuals). The primary outcome was HCC incidence. HCC risk was estimated using multivariable Cox proportional hazard models.

RESULTS:

Among 6,412,209 participants, proportions of non-MASLD, MASLD, MetALD, and ALD cases were 59.5%, 32.4%, 4.8%, and 3.4%, respectively. During follow-up (median 13.3 years), 27,118 had newly developed HCC. Compared with non-MASLD, the HCC risk increased from MASLD (adjusted hazard ratio [aHR] 1.66, 95% confidence interval [CI] 1.62–1.71) and MetALD (aHR 2.17, 95% CI 2.08–2.27) to ALD (aHR 2.34, 95% CI 2.24–2.45) in a stepwise manner. Furthermore, the older and non-cirrhosis subgroups were more vulnerable to detrimental effects of MASLD and/or alcohol intake, concerning HCC risk. Among the older, female, and cirrhosis subgroups, MetALD poses similar HCC risks as ALD.

DISCUSSION:

HCC risk increased from MASLD and MetALD to ALD in a stepwise manner, compared with non-MASLD. For an effective primary prevention of HCC, a comprehensive approach should be required to modify both metabolic dysfunction and alcohol intake habit.