Yun Byungyoon, Park Heejoo, Ahn Sang Hoon, Oh Juyeon, Kim Beom Kyung, Yoon Jin-Ha
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Republic of Korea.
Am J Gastroenterol. 2025 Feb 1;120(2):410-419. doi: 10.14309/ajg.0000000000002920. Epub 2024 Jun 27.
New terminologies of metabolic dysfunction-associated steatotic liver disease (MASLD) have been developed. We assessed hepatocellular carcinoma (HCC) risk across MASLD and/or alcohol intake.
We included participants aged 40-79 years receiving a national health checkup from 2009 to 2010 in the Republic of Korea, classified as follows: non-MASLD, MASLD, MASLD with increased alcohol intake (MetALD; weekly alcohol 210-420 g for male and 140-350 g for female individuals), and alcohol-associated liver disease (ALD; excessive alcohol intake with weekly alcohol ≥420 g for male or ≥350 g for female individuals). The primary outcome was HCC incidence. HCC risk was estimated using multivariable Cox proportional hazard models.
Among 6,412,209 participants, proportions of non-MASLD, MASLD, MetALD, and ALD cases were 59.5%, 32.4%, 4.8%, and 3.4%, respectively. During follow-up (median 13.3 years), 27,118 had newly developed HCC. Compared with non-MASLD, the HCC risk increased from MASLD (adjusted hazard ratio [aHR] 1.66, 95% confidence interval [CI] 1.62-1.71) and MetALD (aHR 2.17, 95% CI 2.08-2.27) to ALD (aHR 2.34, 95% CI 2.24-2.45) in a stepwise manner. Furthermore, the older and non-cirrhosis subgroups were more vulnerable to detrimental effects of MASLD and/or alcohol intake, concerning HCC risk. Among the older, female, and cirrhosis subgroups, MetALD poses similar HCC risks as ALD.
HCC risk increased from MASLD and MetALD to ALD in a stepwise manner, compared with non-MASLD. For an effective primary prevention of HCC, a comprehensive approach should be required to modify both metabolic dysfunction and alcohol intake habit.
代谢功能障碍相关脂肪性肝病（MASLD）已出现新的术语。我们评估了MASLD和/或饮酒情况下肝细胞癌（HCC）的风险。
我们纳入了2009年至2010年在韩国接受全国健康检查的40 - 79岁参与者，分类如下：非MASLD、MASLD、饮酒量增加的MASLD（代谢性酒精性肝病；男性每周饮酒210 - 420克，女性每周饮酒140 - 350克），以及酒精性肝病（ALD；男性每周饮酒≥420克或女性每周饮酒≥350克的过量饮酒）。主要结局是HCC发病率。使用多变量Cox比例风险模型估计HCC风险。
在6412209名参与者中，非MASLD、MASLD、代谢性酒精性肝病和酒精性肝病病例的比例分别为59.5%、32.4%、4.8%和3.4%。在随访期间（中位时间13.3年），27118人新发HCC。与非MASLD相比，HCC风险从MASLD（调整后风险比[aHR] 1.66，95%置信区间[CI] 1.62 - 1.71）和代谢性酒精性肝病（aHR 2.17，95% CI 2.08 - 2.27）逐步增加到酒精性肝病（aHR 2.34，95% CI 2.24 - 2.45）。此外，就HCC风险而言，年龄较大和非肝硬化亚组更容易受到MASLD和/或饮酒的有害影响。在年龄较大、女性和肝硬化亚组中，代谢性酒精性肝病带来的HCC风险与酒精性肝病相似。
与非MASLD相比，HCC风险从MASLD和代谢性酒精性肝病逐步增加到酒精性肝病。为了有效地进行HCC的一级预防，需要一种综合方法来改善代谢功能障碍和饮酒习惯。
