Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease
Lai, Jimmy Che-To Yang, Boyu Lee, Hye Won Lin, Huapeng Tsochatzis, Emmanuel A Petta, Salvatore Bugianesi, Elisabetta Yoneda, Masato Zheng, Ming-Hua Hagström, Hannes
Lai, Jimmy Che-To
Yang, Boyu
Lee, Hye Won
Lin, Huapeng
Tsochatzis, Emmanuel A
Petta, Salvatore
Bugianesi, Elisabetta
Yoneda, Masato
Zheng, Ming-Hua
Hagström, Hannes
Affiliation
The Chinese University of Hong Kong; Yonsei University College of Medicine; Shanghai Jiao Tong University; Royal Free Hospital; University College London; University of Palermo; University of Turin; Yokohama City University Graduate School of Medicine; The First Affiliated Hospital of Wenzhou Medical University; Karolinska Institutet; Karolinska University Hospital; Angers University Hospital; Angers University; Hospital Universitario Puerta de Hierro Majadahonda; Singapore General Hospital; University of Malaya; Virgen del Rocío University Hospital; Virginia Commonwealth University School of Medicine; Echosens; King's College London; King's College Hospital; Xinhua Hospital; Shanghai Jiao Tong University; Université Paris Cité; Assistance Publique-Hôpitaux de Paris; Harvard Medical School; Wenzhou Medical University; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Yonsei University College of Medicine
Other Contributors
Publication date
2025-06-20
Subject
Collections
Research Projects
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Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the general population and is the fastest growing cause of hepatocellular carcinoma (HCC). Current guidelines recommend HCC surveillance in patients with cirrhosis when annual HCC incidence exceeds 1% without specifying the role of non-invasive tests in patient selection.
Objective: To define non-invasive test thresholds to select patients with MASLD for HCC surveillance.
Design: A multicentre longitudinal study of adults with MASLD from 16 tertiary centres in the USA, Europe and Asia between February 2004 and January 2023. Primary outcome was incident HCC.
Results: 12 950 patients had Fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) (mean age 51.7 years; 41.1% male). At a median follow-up of 47.7 (IQR 23.3-72.3) months, 109 (0.8%) developed HCC. FIB-4 was below the low cut-off (<1.3 if aged <65 years and <2.0 if aged ≥65 years), between the low cut-off and <2.67, 2.67 to <3.25, and ≥3.25 in 66.3%, 23.9%, 3.4% and 6.4% of patients; the corresponding annual HCC incidence was 0.07%, 0.17%, 0.77% and 1.18%. As a stand-alone test, the annual HCC incidence exceeded 0.2% for LSM ≥10 kPa and 1% for LSM ≥20 kPa. If LSM was performed as a second step only among patients with FIB-4 above the low cut-off, the annual HCC incidence exceeded 0.2% for LSM ≥10 kPa and 1% for LSM ≥15 kPa.
Conclusion: HCC surveillance should be offered to patients with MASLD with FIB-4 ≥3.25 or LSM ≥20 kPa. When a two-step approach is adopted, LSM ≥15 kPa in patients with increased FIB-4 predicts a high HCC risk.
Citation
Lai JC, Yang B, Lee HW, Lin H, Tsochatzis EA, Petta S, Bugianesi E, Yoneda M, Zheng MH, Hagström H, Boursier J, Calleja JL, Goh GB, Chan WK, Gallego-Duràn R, Sanyal AJ, de Lédinghen V, Newsome PN, Fan JG, Castera L, Lai M, Fournier-Poizat C, Wong GL, Pennisi G, Armandi A, Nakajima A, Liu WY, Shang Y, Saint-Loup M, Llop E, Teh KKJ, Lara-Romero C, Asgharpour A, Mahgoub S, Chan MS, Canivet CM, Romero-Gómez M, Kim SU, Wong VW, Yip TC. Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease. Gut. 2025 Jul 17:gutjnl-2025-334981. doi: 10.1136/gutjnl-2025-334981. Epub ahead of print.
Type
Article