Should we undertake surveillance for HCC in patients with MAFLD?

Abstract

Over the last decade, metabolic-associated fatty liver disease (MAFLD) has become an important public health issue worldwide. In many countries, MAFLD has become the most common cause of chronic liver disease. On the contrary, hepatocellular carcinoma (HCC) mortality is rising. Liver tumors have become the third cause of cancer mortality worldwide. HCC is the most frequent liver tumor. While the burden of HCC related to viral hepatitis is declining, the prevalence of MAFLD-related HCC is rising rapidly. Classical screening criteria for HCC consider cirrhotic, advanced fibrosis, and viral hepatitis patients. Metabolic syndrome with liver involvement or MAFLD is associated with a higher risk of HCC development, even in the absence of cirrhosis. The question about the cost effectiveness of surveillance for HCC in MAFLD is yet not fully answered. There are no guidelines that address the question of when to start or how to define the population who can benefit of surveillance for HCC in MAFLD patients. This review aims to revise the evidence of HCC development in MAFLD. It hopes to be a step closer to defining screening criteria for HCC in MAFLD.

Dysmetabolic comorbidities and non-alcoholic fatty liver disease: a stairway to metabolic dysfunction-associated steatotic liver disease

“…Obesity exacerbates this process by inducing chronic inflammation, activating oncogenic transcription factors like STAT3, and fostering gut dysbiosis with hepatocarcinogenesis promotion [110] . The transition from NAFLD to MAFLD has highlighted its role as a primary cause of HCC [111] . Furthermore, HCC development in MAFLD is closely linked to the degree of fibrosis and can occur in non-cirrhotic livers [112] .…”

Combined effects of smoking and alcohol consumption on the risk of liver cancer according to metabolic syndrome: A nested case–control study in South Korea

“…Metabolic syndrome (MetS) comprises a cluster of metabolic factors, in which diabetes and abdominal obesity are well‐known risk factors for liver cancer 16 . Even if the relative risk of liver cancer for diabetes and obesity is not as high as the risk associated with HBV/HCV, the high prevalence of diabetes and obesity may account for higher population attributable fractions 17 . In the United States, MetS accounted for 41.8% in 2017–2018, 18 attributable to the largest part of the liver cancer burden at the population level 19 .…”

A Machine Learning-Based Method for Detecting Liver Fibrosis

“…In addition to cardiovascular risk and the progression of liver fibrosis, the importance of MASLD diagnosis lies in the possibility of developing hepatocellular carcinoma without cirrhosis. These mechanisms are still unknown [ 10 , 11 , 12 ].…”