Editor's Note: Metabolic-associated steatotic liver disease (MASLD) has become the fastest-growing cause of hepatocellular carcinoma (HCC). A recent multicenter clinical study led by Dr. Carole Vitellius from Angers University Hospital, France, reveals that about one-third of MASLD-related HCC cases occur in patients without cirrhosis. This finding presents new challenges and opportunities for the prevention, diagnosis, and treatment of MASLD-related HCC.Despite the rising incidence of MASLD-related HCC, studies focusing on the clinical characteristics, survival, and prognosis of non-cirrhotic MASLD patients remain limited. The study aimed to uncover clinical features and management strategies by comparing the clinical characteristics, survival, and prognosis between MASLD-related HCC patients with or without cirrhosis from a large multicenter cohort.
The study included 354 MASLD-related HCC patients reported from 2007 to 2018 across four clinical centers in France, with data sourced from the French Cancer Conference database and national birth and death records.
Key Findings:
1. High Proportion of Non-Cirrhotic Patients: The study found that 35% of HCC cases occurred in non-cirrhotic patients.
2. Differences in Diagnostic Methods: Among cirrhotic patients, 60% of HCC cases were detected through screening, while 72% of non-cirrhotic cases were discovered incidentally, often at a more advanced stage.
3. Patient Characteristics: Non-cirrhotic patients were generally older, had heavier tumor burdens, but exhibited better liver function compared to cirrhotic patients.
4. Survival Outcomes: Despite having poor prognostic factors, such as advanced age and larger tumors, non-cirrhotic patients had better overall survival rates than cirrhotic patients (P=0.043). However, cirrhosis was not an independent predictor of survival; independent factors included age, liver function, tumor burden, and BCLC staging.
5. Treatment Strategy Differences: Non-cirrhotic patients were significantly more likely to undergo surgical treatment than cirrhotic patients (41% vs. 11%, P<0.001). Even in cases where the maximum tumor diameter was ≥5 cm or multiple tumors were present, the rate of surgery remained significantly higher.
The study suggests that one-third of MASLD-related HCC patients are non-cirrhotic. Despite challenges like advanced age and larger tumors, better liver function enables these patients to undergo more aggressive treatments, leading to improved survival outcomes.
Researcher’s Perspective:
Dr. Carole Vitellius: “By 2030, the incidence of MASLD-related HCC is expected to increase by 47% to 130%, with one-third of cases occurring in non-cirrhotic MASLD patients. This makes early detection through screening difficult in this population. Understanding the pathophysiology of MASLD-related HCC and identifying non-invasive biomarkers for early prediction are crucial for improving early screening and management strategies.”
