Long-term Risks of Cirrhosis and Hepatocellular Carcinoma Across Steatotic Liver Disease Subtypes

Yi-Ting Chen; Tzu-I Chen; Tsai-Hsuan Yang; Szu-Ching Yin; Sheng-Nan Lu; Xia-Rong Liu; Yun-Zheng Gao; Chih-Jo Lin; Chia-Wei Huang; Jee-Fu Huang; Ming-Lun Yeh; Chung-Feng Huang; Chia-Yen Dai; Wan-Long Chuang; Hwai-I Yang; Ming-Lung Yu; Mei-Hsuan Lee

doi:10.14309/ajg.0000000000002778

Long-term Risks of Cirrhosis and Hepatocellular Carcinoma Across Steatotic Liver Disease Subtypes

Am J Gastroenterol. 2024 Apr 22. doi: 10.14309/ajg.0000000000002778. Online ahead of print.

Authors

Yi-Ting Chen¹, Tzu-I Chen¹, Tsai-Hsuan Yang¹, Szu-Ching Yin¹, Sheng-Nan Lu², Xia-Rong Liu¹, Yun-Zheng Gao¹, Chih-Jo Lin¹, Chia-Wei Huang^{1

3}, Jee-Fu Huang^{4

5

6}, Ming-Lun Yeh^{4

5

6}, Chung-Feng Huang^{4

5

6}, Chia-Yen Dai^{4

5

6}, Wan-Long Chuang^{4

5

6}, Hwai-I Yang^{1

7

8}, Ming-Lung Yu^{4

8

9

10}, Mei-Hsuan Lee^{1

3

8

11}

Affiliations

¹ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Department of Gastroenterology, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
³ Advanced Therapeutics Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
⁸ Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁹ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹⁰ School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹¹ Master of Public Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan.

PMID: 38534155
DOI: 10.14309/ajg.0000000000002778

Abstract

Introduction: The prospective study aimed to investigate the long-term associated risks of cirrhosis and hepatocellular carcinoma (HCC) across various subtypes of steatotic liver disease (SLD).

Methods: We enrolled 332,175 adults who participated in a health screening program between 1997 and 2013. Participants were categorized into various subtypes, including metabolic dysfunction-associated SLD (MASLD), MASLD with excessive alcohol consumption (MetALD), and alcohol-related liver disease (ALD), based on ultrasonography findings, alcohol consumption patterns, and cardiometabolic risk factors. We used computerized data linkage with nationwide registries from 1997 to 2019 to ascertain the incidence of cirrhosis and HCC.

Results: After a median follow-up of 16 years, 4,458 cases of cirrhosis and 1,392 cases of HCC occurred in the entire cohort, resulting in an incidence rate of 86.1 and 26.8 per 100,000 person-years, respectively. The ALD group exhibited the highest incidence rate for cirrhosis and HCC, followed by MetALD, MASLD, and non-SLD groups. The multivariate adjusted hazard ratios for HCC were 1.92 (95% confidence interval [CI] 1.51-2.44), 2.91 (95% CI 2.11-4.03), and 2.59 (95% CI 1.93-3.48) for MASLD, MetALD, and ALD, respectively, when compared with non-SLD without cardiometabolic risk factors. The pattern of the associated risk of cirrhosis was similar to that of HCC (all P value <0.001). The associated risk of cirrhosis for ALD increased to 4.74 (95% CI 4.08-5.52) when using non-SLD without cardiometabolic risk factors as a reference.

Discussion: This study highlights elevated risks of cirrhosis and HCC across various subtypes of SLD compared with non-SLD, emphasizing the importance of behavioral modifications for early prevention.

Abstract

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