Introduction Steatotic liver disease (SLD) is a new overarching term proposed to replace nonalcoholic fatty liver disease and metabolic dysfunction-associated fatty liver disease. Subclassification includes metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. This study aimed to investigate whether SLD and its subclassification could stratify hepatocellular carcinoma (HCC) risk. Methods A cohort of 85,119 adults without viral hepatitis or heavy alcohol intake was analyzed for the risk of HCC according to SLD and its subclassification. The fibrosis-4 (FIB-4) index was used to estimate the degree of liver fibrosis. Results During a median follow-up of 11.9 years, HCC was diagnosed in 123 individuals. The incidence rate of HCC per 1,000 person-years was higher in individuals with SLD than in those without SLD (0.197 vs. 0.071, p < 0.001), with an adjusted hazard ratio of 2.02 (95% confidence interval: 1.40-2.92). The HCC incidence rate per 1,000 person-years was 0, 0.180, and 0.648 for cryptogenic SLD, MASLD, and MetALD, respectively. When participants with SLD was further stratified by the FIB-4 index, the HCC incidence rate per 1,000 person-years was 0.074 for SLD with FIB-4 < 1.3 and 0.673 for SLD with FIB-4 ≥ 1.3. Of note, HCC risk was substantially high (HCC incidence rate: 1.847 per 1,000 person-years) for MetALD with FIB-4 ≥ 1.3. Conclusions HCC risk was different by SLD and its subclassification. The utilization of SLD and its subclassification can aid in stratifying HCC risk and facilitate the identification of individuals requiring interventions to mitigate the risk of HCC.

中文翻译：

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脂肪性肝病导致肝细胞癌的风险及其新提出的亚分类。


简介 脂肪性肝病 （SLD） 是一个新的总称，旨在取代非酒精性脂肪性肝病和代谢功能障碍相关的脂肪肝。亚分类包括代谢功能障碍相关 SLD （MASLD）、酒精摄入增加的 MASLD （MetALD） 和隐源性 SLD。本研究旨在探讨 SLD 及其亚分类是否可以对肝细胞癌 （HCC） 风险进行分层。方法 根据 SLD 及其亚分类，对 85,119 名无病毒性肝炎或酗酒的成年人的队列进行 HCC 风险分析。纤维化-4 （FIB-4） 指数用于估计肝纤维化的程度。结果 在中位随访 11.9 年期间，123 例个体被诊断出 HCC。SLD 患者每 1,000 人年 HCC 的发病率高于无 SLD 的患者 （0.197 vs. 0.071，p < 0.001），调整后的风险比为 2.02 （95% 置信区间： 1.40-2.92）。隐源性 SLD 、 MASLD 和 MetALD 的 HCC 发病率分别为 0 、 0.180 和 0.648 / 1,000 人年。当 SLD 参与者按 FIB-4 指数进一步分层时，FIB-4 < 为 1.3 的 SLD 的 HCC 发病率为每 1,000 人年 0.074，FIB-4 ≥ 1.3 的 SLD 为 0.673。值得注意的是，FIB-4 ≥ 1.3 的 MetALD 的 HCC 风险非常高（HCC 发病率：1.847/1,000 人年）。结论 SLD 及其亚分类的 HCC 风险存在差异。SLD 及其亚分类的利用有助于对 HCC 风险进行分层，并有助于识别需要干预以降低 HCC 风险的个体。