Metabolic Dysfunction‐Associated Steatotic Liver Disease ( MASLD ) Impacts Long‐Term Outcomes After Curative‐Intent Surgery for Hepatocellular Carcinoma

Alimentary Pharmacology & Therapeutics, vol. 61, pp. 1318–1332

Abstract

BACKGROUND: Curative surgery for hepatocellular carcinoma (HCC) includes liver resection (LR) and orthotopic liver transplantation (OLT). Due to the obesity epidemic, metabolic dysfunction-associated steatotic liver disease (MASLD) is a frequent HCC aetiology that often coincides with increased alcohol consumption, termed MetALD, or even alcohol-associated liver disease (ALD). METHODS: Patients undergoing LR or OLT for HCC at Charité-Universitätsmedizin Berlin (2010-2020) were included in this retrospective cohort study investigating disease aetiology, time to recurrence (TTR), overall survival (OS) and CT-based body composition. RESULTS: Out of 579 patients with HCC, 417 underwent LR and 162 OLT. Tumour aetiologies were viral n = 191 (33.0%), MASLD n = 158 (27.3%), MetALD n = 51 (8.8%), ALD n = 68 (11.7%) and other/cryptogenic n = 111 (19.2%). Patients with MASLD and MetALD had more intramuscular (p < 0.001, p = 0.015) and visceral fat (both p < 0.001) than patients with non-metabolic dysfunction aetiologies. Patients with MASLD-HCC had comparable TTR (median 26 months, [95% CI: 23-31] vs. 30 months [95% CI: 4-57], p = 0.425) but shorter OS than patients with other HCC aetiologies (63 months [95% CI: 42-84] vs. 80 months [95% CI: 60-100], hazard ratio: 1.53 [95% CI: 1.050-2.229], p = 0.026) after LR. Multivariate analysis confirmed MASLD aetiology, portal vein thrombosis and MELD score ≥ 10 as independent prognostic factors for OS in LR (adjusted p = 0.021,p < 0.001,p = 0.003), even after excluding in-hospital mortality (adjusted p = 0.016,p = 0.002,p = 0.002). Causes of death were similar in MASLD and non-MASLD aetiology. CONCLUSIONS: Patients with HCC undergoing LR and meeting the new MASLD criteria have significantly shorter OS. This study provides empirical prognostic evidence for the novel MASLD/MetALD classification in a large European cohort of patients undergoing curative-intent HCC therapy.

Authors 14

1. Deniz Uluk

   Heidelberg University · Charité - Universitätsmedizin Berlin · University Hospital Heidelberg · Chirurgische Universitätsklinik Heidelberg

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital Heidelberg Germany

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

2. Justus Pein

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

3. Frederik Schliephake

   Heidelberg University · Charité - Universitätsmedizin Berlin · University Hospital Heidelberg · Chirurgische Universitätsklinik Heidelberg

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital Heidelberg Germany

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

4. Carolin Victoria Schneider Aachen Department of Medicine III

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Medicine III University Hospital RWTH Aachen Aachen Germany

   Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany

5. Dennis Eurich

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

6. Ingrid Wei Zhang

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

7. Lukas Schaffrath

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

8. Timo Alexander Auer

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Radiology Charité – Universitätsmedizin Berlin Berlin Germany

9. Federico Collettini

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Radiology Charité – Universitätsmedizin Berlin Berlin Germany

10. Cornelius Engelmann

    Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

11. Frank Tacke

    Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

12. Johann Pratschke

    Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

13. Isabella Lurje

    Heidelberg University · Charité - Universitätsmedizin Berlin · University Hospital Heidelberg · Chirurgische Universitätsklinik Heidelberg

    Affiliation as printed

    Department of Gastroenterology and Hepatology, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

    Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital Heidelberg Germany

    Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany

14. Georg Lurje corresponding

    Heidelberg University · Charité - Universitätsmedizin Berlin · University Hospital Heidelberg · Chirurgische Universitätsklinik Heidelberg

    Affiliation as printed

    Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital Heidelberg Germany

    Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany

    Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum Charité‐Universitätsmedizin Berlin Berlin Germany