Song Byeong Geun, Choi Sung Chul, Goh Myung Ji, Kang Wonseok, Sinn Dong Hyun, Gwak Geum-Youn, Paik Yong-Han, Choi Moon Seok, Lee Joon Hyeok, Paik Seung Woon
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Health Promotion, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
JHEP Rep. 2023 Jun 28;5(9):100810. doi: 10.1016/j.jhepr.2023.100810. eCollection 2023 Sep.
BACKGROUND & AIMS: The metabolic dysfunction-associated fatty liver disease (MAFLD) is a new inclusive term proposed to replace non-alcoholic fatty liver disease (NAFLD). We analysed whether hepatocellular carcinoma (HCC) risk differs by MAFLD or NAFLD status in a large sample of asymptomatic adults.
A cohort comprising 73,691 adults were followed up for the development of HCC. NAFLD was diagnosed among participants without other liver diseases (n = 65,992).
Participants with MAFLD showed higher incidence of HCC than those without MAFLD (0.37 and 0.24 per 1,000 person-years, respectively; = 0.006). However, MAFLD was not an independent factor associated with HCC in multivariable adjusted analysis (hazard ratio [HR] 1.21; 95% CI 0.92-1.60). When stratified according to presence of other liver diseases, MAFLD was not associated with HCC in participants with other liver diseases. In participants without other liver diseases, both MAFLD (adjusted HR 1.84; 95% CI 1.09-3.11) and NAFLD (adjusted HR 1.71; 95% CI 1.01-2.90) were independent factors associated with HCC. When stratified according to NAFLD and MAFLD status, there was no HCC development among participants with NAFLD only during 8,936 person-years of follow-up, but this NAFLD-only group comprised 3.4%, and the majority of participants with hepatic steatosis fulfilled both NAFLD and MAFLD criteria.
In patients with other chronic liver diseases, the presence of MAFLD is not independently associated with an increased risk of HCC. For those without other chronic liver diseases, MAFLD largely overlaps with NAFLD and is associated with an increased risk of HCC.
This study investigated the usefulness of newly proposed nomenclature, metabolic dysfunction-associated fatty liver disease (MAFLD), over non-alcoholic fatty liver disease (NAFLD), in terms of predicting hepatocellular carcinoma. In patients with other chronic liver diseases, the presence of MAFLD is not independently associated with an increased risk of HCC. However, for those without chronic liver disease, MAFLD largely overlaps with NAFLD and is associated with an increased risk of HCC.
代谢功能障碍相关脂肪性肝病（MAFLD）是一个新提出的综合性术语，用以取代非酒精性脂肪性肝病（NAFLD）。我们在大量无症状成年人样本中分析了MAFLD或NAFLD状态对肝细胞癌（HCC）风险的影响是否存在差异。
对一个包含73,691名成年人的队列进行随访，观察HCC的发生情况。在无其他肝脏疾病的参与者中诊断出NAFLD（n = 65,992）。
MAFLD参与者的HCC发病率高于无MAFLD者（分别为每1000人年0.37和0.24；P = 0.006）。然而，在多变量调整分析中，MAFLD并非与HCC相关的独立因素（风险比[HR] 1.21；95%置信区间0.92 - 1.60）。根据是否存在其他肝脏疾病进行分层时，MAFLD与有其他肝脏疾病的参与者的HCC无关。在无其他肝脏疾病的参与者中，MAFLD（调整后HR 1.84；95%置信区间1.09 - 3.11）和NAFLD（调整后HR 1.71；95%置信区间1.01 - 2.90）均为与HCC相关的独立因素。根据NAFLD和MAFLD状态进行分层时，仅患有NAFLD的参与者在8936人年的随访期间未发生HCC，但该仅患有NAFLD的组占3.4%，且大多数肝脂肪变性参与者同时符合NAFLD和MAFLD标准。
在患有其他慢性肝病的患者中，MAFLD的存在并非独立与HCC风险增加相关。对于那些无其他慢性肝病的患者，MAFLD在很大程度上与NAFLD重叠，且与HCC风险增加相关。
本研究探讨了新提出的术语代谢功能障碍相关脂肪性肝病（MAFLD）相较于非酒精性脂肪性肝病（NAFLD）在预测肝细胞癌方面的实用性。在患有其他慢性肝病的患者中，MAFLD的存在并非独立与HCC风险增加相关。然而，对于那些无慢性肝病的患者，MAFLD在很大程度上与NAFLD重叠，且与HCC风险增加相关。
