ArticleJournal of gastroenterology2026
Alcohol involvement may modify the association between previous hepatitis B virus infection and hepatocellular carcinoma risk in steatotic liver disease.
Article in Journal of gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
aimsMetabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) are emerging hepatocellular carcinoma (HCC) etiologies. Prior-HBV-infection (pHBV) has been linked to HCC in HBsAg-negative populations, but phenotype-specific effects across steatotic liver disease (SLD) remain unclear. We examined whether pHBV modifies 5-year HCC risk by SLD etiology.
methodsWe analyzed 623 of 1116 patients with hepatic steatosis managed at a single center (2009-2024). pHBV was defined as HBsAg- and HBV DNA-negative status with anti-HBc and/or anti-HBs positivity. The primary endpoint was the 5-year cumulative HCC incidence. Kaplan-Meier, PSM, IPTW, and Cox interaction models were used.
resultspHBV was present in 152 patients (24.4%). Overall, pHBV was not associated with 5-year HCC after PSM (150 pairs; 6.58% vs. 5.60%; log-rank P = 0.701) or IPTW (3.80% vs. 4.27%; HR 0.97, 95% CI 0.37-2.54; P = 0.874). In MASLD/cryptogenic SLD, pHBV was associated with lower HCC incidence (PSM 1.32% vs. 9.53%, P = 0.027; IPTW 0.86% vs. 4.35%, P = 0.048). In ALD/MetALD, pHBV showed a borderline higher incidence (PSM 16.17% vs. 3.45%, P = 0.053; IPTW 12.78% vs. 3.99%, P = 0.073). Interaction analyses supported heterogeneity across etiologies (IPTW HR 12.96, P = 0.024; PSM HR 25.87, P = 0.034, Cox HR 7.83, P = 0.057).
conclusionsIn HBsAg-negative SLD, the association between pHBV and HCC risk appears to differ according to alcohol involvement, with a potentially increased HCC risk in ALD/MetALD and a lower observed HCC incidence in MASLD/cryptogenic disease that requires cautious interpretation.
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