Impact of MAFLD on HBV-Related Stage 0/A Hepatocellular Carcinoma after Curative Resection.

Yen-Po Lin,Ding-Wei Chen,Ming-Chao Tsai,Chao-Hung Hung,Wei-Ru Cho,Ching-Hui Chuang,Chih-Chi Wang,Pao-Yuan Huang,Shu-Hsien Lin,Chih-Che Lin,Yu-Syuan Chen,Shih-Yu Yang

doi:10.3390/jpm11080684

Abstract

Backgrounds and Aim: Metabolic-associated fatty liver dis-ease (MAFLD) is a novel term proposed in 2020 to avoid the exclusion of certain subpopulations, though the application of this term in the real world is very limited. Here, we aimed to evaluate the impact of MAFLD on hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative resection. Methods: Patients with chronic hepatitis B (CHB)-related HCC who received hepatectomy between January 2010 and December 2019 were consecutively selected. The association between histologically proven concurrent MAFLD and clinical outcomes were retrospectively analyzed. Results: Among the 812 eligible patients with CHB-related HCC, 369 (45.4%) were diagnosed with concurrent MAFLD. After a mean follow-up of 65 months, 303 patients (37.3%) developed HCC recurrence, 111 (13.7%) died, and 12 (1.5%) received liver transplantation. Although no differences in the incidences of HCC recurrence (HR: 0.902, 95% CI: 0.719–1.131, p = 0.370) and death or liver transplantation (HR: 0.743, 95% CI: 0.518–1.006, p = 0.107) were observed between patients with and without MAFLD in multivariate analysis, the patients with MAFLD tended to achieve better recurrent-free survival compared to patients without MAFLD. Notably, lean MAFLD (BMI < 23 kg/m2) was a relative risk factor for tumor recurrence (HR: 2.030, 95% CI: 1.117–3.690, p = 0.020) among patients with MAFLD. Conclusions: The overall prognosis in HBV-related early-stage HCC, in terms of HCC recurrence and death or liver transplantation, was not significantly different between patients with and without MAFLD. Among patients with MALFD, lean-MAFLD was a risk factor for HCC recurrence. Further studies are warranted to validate these results.

Highlights

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer worldwide and ranks fourth in terms of cancer mortality [1,2]
The data were obtained from the Chang Gung Research Database (CGRD), which is derived from the largest private hospital system in Taiwan, Chang Gung Memorial Hospital (CGMH); the database is systematically updated annually to include new data generated at CGMH
Ultimate remaining 812 patients were eligible for this analysis (Figure 1); 443 patients had wreimthainMinAg F81L2Dpa(ttihenetsMwAerFeLelDigigblreofuorpt)haisnadnatlhyseiso(tFhigeurr3e 619); 4p4a3tpieantitesnths ahdadHHCCCC wwitihthout M (MntohAne-FMnLoDAnF(-LtMhDeAgMrFoALuFDpL)D.grgorouupp)). and the other 369 patients had HCC without metabolic-associated fatty liver disease (MAFLD)

Summary

Introduction

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer worldwide and ranks fourth in terms of cancer mortality [1,2]. The high incidence of HCC in Asia compared to other regions of the world is related to the predominance of chronic hepatitis B (CHB) [3]. Several factors are prognostic for recurrence after HCC resection, including tumor size and differentiation, serum α-fetoprotein (AFP), microvascular invasion, cirrhosis, surgical margin, and metabolic syndrome [5,9,10]. Over the past four decades, non-alcoholic fatty liver dis-ease (NAFLD) has become the most prevalent chronic liver disease worldwide, in line with the increased prevalence of the features of metabolic syndrome [11,12]. The association be-tween non-alcoholic fatty liver disease (NAFLD) and HCC was well established recently [13]. Considering that CHB is endemic in the Asia-Pacific region, the prevalence of concurrent NAFLD in HBV-related HCC is expected to increase. Data regarding the impact of NAFLD on HBVrelated HCC is scarce

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