Concurrent Steatotic Liver Disease and Prognosis After Curative Resection of Hepatocellular Carcinoma.

Purpose: Steatotic liver disease (SLD), linked to obesity and metabolic disorders, is a growing health burden. While implicated in hepatocarcinogenesis, its prognostic role in resectable hepatocellular carcinoma (HCC) is unclear, with conflicting reports and uncertain interaction with viral hepatitis. We aimed to evaluate the impact of concurrent SLD on recurrence-free (RFS) and overall survival (OS) in HCC, and to explore differences across etiologic subgroups. Patients and methods: In this retrospective cohort study, we analyzed 2123 HCC patients who underwent curative hepatic resection between 2009 and 2023. Patients were stratified by histologically defined SLD (≥5% steatosis in non-tumorous liver). Primary outcomes were RFS and OS. Subgroup analyses were performed by HCC etiology. Results: SLD was present in 52.2% of patients and associated with favorable metabolic and tumor profiles. While RFS did not differ between groups (P = 0.942), patients with SLD had significantly improved OS (P = 0.001). On multivariate analysis, SLD remained an independent protective factor for mortality (HR 0.76, P = 0.005). The survival benefit was most evident in chronic hepatitis B (CHB) patients (HR 0.71, P = 0.011), and SLD was associated with significantly lower risks of both liver-related mortality (P=0.006) and non-liver-related mortality (P=0.001). Conclusion: Concurrent SLD was associated with improved overall survival after curative resection for HCC, particularly among patients with CHB. These findings suggest that SLD may represent a clinically relevant prognostic factor in resectable HCC; however, the observed association should be regarded as hypothesis-generating and requires prospective validation.