Adali Gupse, Aykut Huseyin, Bilgic Nermin Mutlu, Yilmaz Yusuf
Department of Gastroenterology, University of Health Sciences, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkiye.
Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkiye.
Heliyon. 2024 Sep 18;10(18):e37990. doi: 10.1016/j.heliyon.2024.e37990. eCollection 2024 Sep 30.
Chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) are the leading causes of hepatocellular carcinoma (HCC). This study aimed to explore the impact of baseline MASLD on the risk of HCC development in patients with CHB receiving antiviral treatment.
We consecutively recruited 535 patients with CHB who initiated antiviral treatment between January 2007 and January 2023. The exclusion criteria included coexisting HDV, HCV, or HIV infection; other chronic liver diseases; extrahepatic malignancies; prior HCC; and HCC development within one year. A baseline liver biopsy was performed in 467 patients (87 %). MASLD was defined as hepatic steatosis diagnosed histologically or by imaging, combined with one cardiometabolic risk factor. The cumulative incidence of HCC and its associated factors was analyzed in patients with CHB, with and without MASLD.
In total, 535 treatment-naïve patients with CHB were included, with a median follow-up of 6.05 years. MASLD was not associated with an increased incidence of HCC in patients with CHB (HR: 1.17; 95 % CI: 0.77-1.79; p = 0.466). The cumulative incidence of HCC increased with the number of fulfilled cardiometabolic criteria (0-2 criteria vs. ≥ 3 criteria) (HR: 3.93; 95 % CI: 1.89-8.19; p < 0.001).Age (HR: 1.03, 95 % CI 1.01-1.06, p = 0.010), male sex (HR: 3.17; 95 % CI 1.34-7.53, p = 0.009), diabetes (HR: 2.81; 95 % CI 1.54-5.12, p < 0.001), and cirrhosis (HR:3.03; 95 % CI 1.57-5.5.86, p < 0.001) were independently associated with HCC development.
It was not MASLD, but rather the presence of multiple cardiometabolic risk factors in patients with CHB that was associated with the risk of HCC in those receiving antiviral treatment. Furthermore, older age, male sex, diabetes, and cirrhosis aggravated the risk of HCC in patients with CHB.
慢性乙型肝炎（CHB）和代谢功能障碍相关脂肪性肝病（MASLD）是肝细胞癌（HCC）的主要病因。本研究旨在探讨基线MASLD对接受抗病毒治疗的CHB患者发生HCC风险的影响。
我们连续招募了535例在2007年1月至2023年1月期间开始抗病毒治疗的CHB患者。排除标准包括合并HDV、HCV或HIV感染；其他慢性肝病；肝外恶性肿瘤；既往HCC；以及一年内发生HCC。467例患者（87%）进行了基线肝活检。MASLD定义为经组织学或影像学诊断的肝脂肪变性，并伴有一种心脏代谢危险因素。分析了有和没有MASLD的CHB患者中HCC的累积发病率及其相关因素。
总共纳入了535例初治CHB患者，中位随访时间为6.05年。MASLD与CHB患者HCC发病率增加无关（HR：1.17；95%CI：0.77 - 1.79；p = 0.466）。HCC累积发病率随着满足的心脏代谢标准数量增加而增加（0 - 2项标准与≥3项标准）（HR：3.93；95%CI：1.89 - 8.19；p < 0.001）。年龄（HR：1.03，95%CI 1.01 - 1.06，p = 0.010）、男性（HR：3.17；95%CI 1.34 - 7.53，p = 0.009）、糖尿病（HR：2.81；95%CI 1.54 - 5.12，p < 0.001）和肝硬化（HR：3.03；95%CI 1.57 - 5.586，p < 0.001）与HCC发生独立相关。
与接受抗病毒治疗的CHB患者发生HCC风险相关的不是MASLD，而是CHB患者中多种心脏代谢危险因素的存在。此外，年龄较大、男性、糖尿病和肝硬化会加重CHB患者发生HCC的风险。
