HCC risk higher in MASLD patients who smoke, drink alcohol

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at greater risk of developing incident hepatocellular carcinoma (HCC) when factors such as smoking, alcohol use, obesity, diabetes, and hypertension are present, according to a study. However, use of statin, metformin, or aspirin may modify disease progression.

The electronic databases of PubMed, Embase, and the Cochrane Library were searched from inception through 1 April 2023 for observational studies reporting an association between modifiable risk factors and MASLD-related HCC. The authors then calculated the effect size on study outcomes using a random-effects model, presented as a risk ratio (RR) with 95 percent confidence interval (CI).

Thirty-one studies involving 1.02 million individuals met the eligibility criteria. Smoking (RR, 1.30, 95 percent CI, 1.08–1.57) and alcohol intake (RR, 2.41, 95 percent CI, 1.03–5.65) significantly contributed to the risk increase of MASLD-related HCC.

Similarly, overweight or obesity (RR, 1.31, 95 percent CI, 1.13–1.52), diabetes (RR, 2.08, 95 percent CI, 1.71–2.53), and hypertension (RR, 1.42, 95 percent CI, 1.12–1.80) correlated with a higher risk of HCC development, whereas dyslipidemia showed a negative association with MASLD-related HCC (RR, 0.78, 95 percent CI, 0.65–0.93).

On the other hand, use of metformin (RR, 0.82, 95 percent CI, 0.68–0.98), statin (RR, 0.45, 95 percent CI, 0.36–0.56), and aspirin (RR, 0.64, 95 percent CI, 0.44–0.92) provided protective benefits, resulting in a reduced risk in incident HCC.