MASLD-related HCC: Multicenter study comparing patients with and without cirrhosis

Area of Science:

• Hepatology
• Oncology
• Metabolic Diseases

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasing cause of hepatocellular carcinoma (HCC).
• HCC in non-cirrhotic MASLD livers is poorly understood.
• MASLD-related HCC incidence is projected to rise significantly by 2030.

Purpose of the Study:

• To compare characteristics, management, survival, and trends of MASLD-related HCC in patients with and without cirrhosis.
• To investigate prognostic factors for MASLD-related HCC.
• To evaluate treatment strategies for MASLD-related HCC in non-cirrhotic patients.

Main Methods:

• Retrospective analysis of 354 MASLD-related HCC cases from four French university hospitals (2007-2018).
• Data extracted from liver tumor board databases and French Birth and Death Registry.
• Comparison of patient characteristics, tumor burden, liver function, management, and survival between cirrhotic and non-cirrhotic groups.

Main Results:

• 35% of MASLD-related HCC cases occurred in non-cirrhotic livers.
• Non-cirrhotic patients were older with larger tumors but better liver function.
• Non-cirrhotic patients underwent surgery more frequently (41% vs. 11%) and had better overall survival (p=0.043).
• Cirrhosis was not an independent predictor of survival; age, liver function, tumor burden, and BCLC classification were key factors.

Conclusions:

• MASLD-related HCC in non-cirrhotic patients presents with adverse prognostic factors but better liver function.
• Aggressive management, including surgery, is feasible and leads to better survival in non-cirrhotic patients.
• Understanding non-cirrhotic MASLD-HCC pathophysiology is crucial for early screening and management.