Hepatocellular Carcinoma Among Patients With Metabolic Dysfunction Associated Steatotic Liver Disease.

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of cirrhosis and hepatocellular carcinoma (HCC). We decided to determine factors associated with cirrhosis and HCC among patients with MASLD in order to help develop a better HCC surveillance strategy. Methods: We retrieved Veterans Affairs data and identified patients with MASLD. Each patient with cirrhosis was propensity-matched to 3 patients without cirrhosis for age, sex, and race. The 2 groups were compared for demographics, clinical features, and comorbidities, and the incidence and factors associated with cirrhosis and HCC were determined. Results: Among 118,754 veterans noted to have MASLD, 74,475 were excluded. In the residual cohort of 44,279, 4844 patients had cirrhosis who were matched to 14,502 patients without cirrhosis. The median age was 61 years, 94% were men, and 62% were White. Patients with cirrhosis had higher body mass index, 45% had diabetes, and the majority had dyslipidemia and hypertension. The incidence rate of HCC in patients with cirrhosis was 9.9 per 1000 person-years, and among noncirrhotic patients, it was 0.3 per 1000 person-years. In the study cohort, age, male sex, and cirrhosis increased the likelihood of HCC, whereas Black race and pulmonary disease reduced the risk. Patients with cirrhosis had similar findings, whereas among those without cirrhosis, chronic kidney disease was associated with increased risk. Conclusion: Among patients with MASLD, advancing age, male sex, and cirrhosis were the dominant risk factors for HCC development. Similar associations were noted in patients with cirrhosis, whereas among those without cirrhosis, chronic kidney disease increased the likelihood of HCC.