{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong",
        "Li Ka Shing Institute of Helath Sciences and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Jimmy Che-To Lai"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Boyu Yang"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Hye Won Lee"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China"
      ],
      "name": "Huapeng Lin"
    },
    {
      "affiliations": [
        "University College London Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK"
      ],
      "name": "Emmanuel A Tsochatzis"
    },
    {
      "affiliations": [
        "Sezione di Gastroenterologia, Di.Bi.M.I.S, University of Palermo, Palermo, Italy"
      ],
      "name": "Salvatore Petta"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy"
      ],
      "name": "Elisabetta Bugianesi"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan"
      ],
      "name": "Masato Yoneda"
    },
    {
      "affiliations": [
        "MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China"
      ],
      "name": "Ming-Hua Zheng"
    },
    {
      "affiliations": [
        "Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden",
        "Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden"
      ],
      "name": "Hannes Hagström"
    },
    {
      "affiliations": [
        "Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France",
        "HIFIH Laboratory, SFR ICAT 4208, Angers University, Angers, France"
      ],
      "name": "Jerome Boursier"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain"
      ],
      "name": "Jose Luis Calleja"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore"
      ],
      "name": "George Boon-Bee Goh"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"
      ],
      "name": "Wah-Kheong Chan"
    },
    {
      "affiliations": [
        "Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain"
      ],
      "name": "Rocìo Gallego-Duràn"
    },
    {
      "affiliations": [
        "Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA"
      ],
      "name": "Arun J Sanyal"
    },
    {
      "affiliations": [
        "Echosens, Paris, France"
      ],
      "name": "Victor de Lédinghen"
    },
    {
      "affiliations": [
        "Roger Williams Institute of Liver Studies, Faculty of Life Sciences and Medicine, King’s College London, the Foundation of Liver Research, and King’s College Hospital, London, UK"
      ],
      "name": "Philip Noel Newsome"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China"
      ],
      "name": "Jian-Gao Fan"
    },
    {
      "affiliations": [
        "Université Paris Cité, UMR1149 (CRI), INSERM, Paris, France",
        "Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France"
      ],
      "name": "Laurent Castera"
    },
    {
      "affiliations": [
        "Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Michelle Lai"
    },
    {
      "affiliations": [
        "Echosens, Paris, France"
      ],
      "name": "Céline Fournier-Poizat"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong",
        "Li Ka Shing Institute of Helath Sciences and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Grace Lai-Hung Wong"
    },
    {
      "affiliations": [
        "Sezione di Gastroenterologia, Di.Bi.M.I.S, University of Palermo, Palermo, Italy"
      ],
      "name": "Grazia Pennisi"
    },
    {
      "affiliations": [
        "Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy"
      ],
      "name": "Angelo Armandi"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan"
      ],
      "name": "Atsushi Nakajima"
    },
    {
      "affiliations": [
        "Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"
      ],
      "name": "Wen-Yue Liu"
    },
    {
      "affiliations": [
        "Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Ying Shang"
    },
    {
      "affiliations": [
        "Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France"
      ],
      "name": "Marc de Saint-Loup"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain"
      ],
      "name": "Elba Llop"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore"
      ],
      "name": "Kevin Kim Jun Teh"
    },
    {
      "affiliations": [
        "Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain"
      ],
      "name": "Carmen Lara-Romero"
    },
    {
      "affiliations": [
        "Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA"
      ],
      "name": "Amon Asgharpour"
    },
    {
      "affiliations": [
        "National Institute for Health Research, Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK"
      ],
      "name": "Sara Mahgoub"
    },
    {
      "affiliations": [
        "Echosens, Paris, France"
      ],
      "name": "Mandy Sau-Wai Chan"
    },
    {
      "affiliations": [
        "Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France",
        "HIFIH Laboratory, SFR ICAT 4208, Angers University, Angers, France"
      ],
      "name": "Clemence M Canivet"
    },
    {
      "affiliations": [
        "Digestive Diseases Unit and CIBERehd, Virgen del Rocío University Hospital, Seville, Spain"
      ],
      "name": "Manuel Romero-Gómez"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea"
      ],
      "name": "Seung Up Kim"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong",
        "Li Ka Shing Institute of Helath Sciences and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Vincent Wai-Sun Wong"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong",
        "Li Ka Shing Institute of Helath Sciences and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Terry Cheuk-Fung Yip"
    }
  ],
  "title": "Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease",
  "uid": "4c4fc531-5e7b-5ac3-b491-765fe390c858"
}