The binary diagnostic approach does not reflect the entire spectrum of metabolic dysfunction associated steatotic liver disease (MASLD. We used an elastography technology, dual elastography ultrasound (DEUS), to discriminate the different stages of MASLD. This prospective multicenter study was conducted from December 2020 to March 2022. All patients underwent DEUS scan, a liver biopsy, and a liver function laboratory test. The optimal model was developed (ModelDEUSC) with 10 machine learning algorithms by combining DEUS and selected clinical parameters and tested the diagnostic accuracy for distinguishing the three progression stages of MASLD: low-, intermediate-, and high-risk. The diagnostic ability of ModelDEUSC for MASH with advanced fibrosis (≥ F3) was compared with other four non-invasive tests. The study included 312 patients in the derivation cohort and 135 in the validation cohort (7:3). Combining DEUS and clinical parameters, a ternary classification of MASLD in the validation cohort achieved a macro-average AUC of 0.858 (95% CI: 0.793, 0.925). The AUC for the diagnosis of MASH with ≥ F3 fibrosis of ModelDEUSC was 0.886 (95% CI: 0.813, 0.824), which was superior to FAST, FIB-4, NFS, and APRI (0.822, 0.657, 0.688, and 0.659). Moreover, ModelDEUSC demonstrated favorable performance for distinguishing stages of liver fibrosis (F1 to F4), inflammation (G1 to G4), and steatosis (S1 to S4). Stratification analysis showed that the ability of ModelDEUSC was not influenced by diabetes and obesity. Multicenter data analysis demonstrated DEUS' advanced ability in continuous stratification of MASLD, which will provide a low-cost, easily accessible, and accurate noninvasive tools (NIT) for MASLD.

Hepatocellular carcinoma (HCC) remains a major health burden in Asia. Advances in antiviral therapies are reshaping the etiological landscape of HCC. This study evaluated temporal shifts in HCC etiology across Asian countries and their clinical implications. This multinational study analyzed 6,261 newly diagnosed HCC patients registered in the APASL Hepatology/Oncology Consortium (A-HOC) from 19 centers across seven Asian countries and regions between 2013 and 2023. Data on demographics, tumor characteristics, etiology, and treatment patterns were collected. Etiologies included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), metabolic dysfunction-associated fatty liver disease (MAFLD), MAFLD plus excess alcoholic intake (MAFLD + eAL), autoimmune liver disease, cryptogenic, and others. Temporal trends and regional variations were assessed. In many countries, HBV remained predominant (43.3%-69.5%) and relatively stable throughout the period, while HCV showed only modest reductions. In Japan, HCV was the leading cause of HCC (33.1%), with a significant decline over time, accompanied by a rise in MAFLD-related HCC. ALD-related HCC increased in South Korea, and MAFLD-related HCC rose in Turkey. Tumor size and stage at diagnosis varied by etiology and region, affecting treatment strategies. Early-stage diagnosis was more frequent in Japan and Taiwan, whereas advanced-stage HCC was common in China and Indonesia. Distinct regional patterns and temporal changes in HCC etiology across Asia highlight the need for tailored prevention and surveillance measures. The growing burden of MAFLD-related HCC emphasizes its emerging role in liver cancer development, particularly in regions with declining viral hepatitis.