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HEPATOCELLULAR CARCINOMA IN METABOLIC-ASSOCIATED FATTY LIVER DISEASE (MAFLD) VERSUS OTHER RISK FACTORS
Abiha Abdullah
*, Sethi Vrishketan, Christopher Buros, Arefan Dooman, Marta I Minervini, Alessandro Furlan, Wu Shadong, Michele Molinari
University of Pittsburgh, Pittsburgh, PA
Introduction:
The surge in hepatocellular carcinoma (HCC) cases in North America is closely tied to the increasing prevalence of metabolic-associated fatty liver disease (MAFLD). Despite growing recognition of MAFLD as a key player in HCC, its influence on tumor behavior and patient outcomes remains unclear. This study seeks to uncover whether HCC in the setting of MAFLD represents a distinct clinical entity, driving new insights into prognosis and management strategies.
Methods:
A retrospective analysis of 154 adult patients who underwent curative-intent hepatic resection for HCC at a major U.S. transplant center between January 1, 2011, and December 31, 2020, was conducted, with follow-up until December 31, 2023. Patients were stratified into MAFLD-positive (n=89) and MAFLD-negative (n=67) groups. Detailed demographic, clinical, and oncological data were analyzed. Survival outcomes were assessed using Kaplan-Meier analysis, and multivariate Cox regression was applied to adjust for confounding factors, aiming to identify novel risk predictors.
Results:
Compared to MAFLD-negative patients, MAFLD-positive patients were older (mean age 70.1 vs. 67.4 years, p=0.043), more frequently obese (55% vs. 18%, p<0.001), and had a significantly lower prevalence of cirrhosis (27% vs. 64%, p<0.001). Tumor size was larger in the MAFLD-positive group (mean 5.6 cm vs. 3.8 cm, p=0.004), though there was no significant difference in tumor differentiation or T stage. MAFLD-positive patients had superior progression-free survival (PFS) (median 2.80 vs. 1.21 years, p=0.002), with a hazard ratio of 0.64 (95% CI: 0.42–0.96). Although overall survival (OS) was longer in MAFLD-positive patients (median 4.55 vs. 2.54 years), the difference was not statistically significant (p=0.09). After adjusting for confounders, MAFLD did not emerge as an independent predictor for OS or PFS, while the presence of cirrhosis, AFP >100 ng/mL, and advanced tumor stage remained significant risk factors.
Conclusion:
Contrary to previous research suggesting different biological behavior and prognosis of HCC in MAFLD, our findings reveal that MAFLD-positive and MAFLD-negative patients have similar overall and progression-free survival when adjusting for tumor stage, serum AFP, and cirrhosis. This observation challenges the notion of MAFLD as an independent predictor for HCC.
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