Liver and Bile
Gut. 2023;72(1):141–52
Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002–2033: The ITA.LI.CA database
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a new inclusive definition of the whole spectrum of liver diseases associated to metabolic disorders. The main objective of this study was to compare patients with MAFLD and non-MAFLD with hepatocellular carcinoma (HCC) included in a nationally representative cohort.
Methods: The authors analyzed 6882 consecutive patients with HCC enrolled from 2002 to 2019 by 23 Italian Liver Cancer centers to compare epidemiological and future trends in 3 subgroups: pure, single-etiology MAFLD (S-MAFLD); mixed-etiology MAFLD (metabolic and others, M-MAFLD); and non-MAFLD HCC.
Results: MAFLD was diagnosed in the majority of patients with HCC (68.4%). The proportion of both total MAFLD and S-MAFLD HCC significantly increased over time (from 50.4% and 3.6% in 2002–2003, to 77.3% and 28.9% in 2018–2019, respectively; p < 0.001). In Italy S-MAFLD HCC is expected to overcome M-MAFLD HCC in about 6 years. Patients with S-MAFLD HCC were older, more frequently men and less frequently cirrhotic with clinically relevant portal hypertension and a surveillance-related diagnosis. They had more frequently large tumors and extrahepatic metastases. After weighting, and compared with patients with non-MAFLD, S-MAFLD and M-MAFLD HCC showed a significantly lower overall (p = 0.026, p = 0.004) and HCC-related (p < 0.001, for both) risk of death. Patients with S-MAFLD HCC showed a significantly higher risk of non-HCC-related death (p = 0.006).
Conclusions: The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) with hepatocellular carcinoma (HCC) in Italy is rapidly increasing to cover the majority of patients with HCC. Despite a less favorable cancer stage at diagnosis, patients with MAFLD HCC have a lower risk of HCC-related death, suggesting reduced cancer aggressiveness.