{
  "abstract": "Background Coexistence of metabolic dysfunction-associated steatotic liver disease (MASLD) increases hepatocellular carcinoma (HCC) risk after HCV cure.Objective The specific impacts of steatosis grade and cardiometabolic burden on HCC risk among patients with MASLD remain unclear.Design We enrolled 700 patients who underwent biannual HCC surveillance after HCV cure. Steatosis was graded by vibration-controlled transient elastography using controlled attenuation parameter cut-offs of 248–267, 268–279 and ≥280 dB/m, corresponding to S1, S2 and S3, respectively. Cardiometabolic risk factors (CMRFs) were assessed at the time of viral cure. Cumulative HCC incidence was compared across steatosis grades and cardiometabolic burdens using the log-rank test. Multivariable Cox proportional hazards models with Akaike Information Criterion-based selection evaluated the effects of steatosis grade, cardiometabolic burden and individual CMRFs on HCC risk, expressed as adjusted HRs (aHRs) with 95% CIs. Fine-Gray subdistribution hazard models were used for sensitivity analyses.Results Cumulative HCC incidence differed significantly across steatosis grades (p=0.035) but not across cardiometabolic burdens (p=0.62). In multivariable analysis adjusted for age, sex, liver stiffness and alpha-fetoprotein, advanced steatosis remained independently associated with HCC risk (S3 vs S1: aHR 2.15, 95% CI 1.25 to 3.69, p=0.005). Among individual CMRFs, pre-diabetes or type 2 diabetes was significantly associated with HCC risk (aHR 2.33, 95% CI 1.38 to 3.94, p=0.002). Fine-Gray analyses confirmed these associations.Conclusion Advanced hepatic steatosis and glycaemic abnormalities, rather than overall cardiometabolic burden, are independently associated with increased HCC risk after HCV cure.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsinchu, Taiwan"
      ],
      "name": "Yu-Ping Chang"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"
      ],
      "name": "Yun-Chu Chen"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan"
      ],
      "name": "Pin-Nan Cheng"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan"
      ],
      "name": "Yu-Jen Fang"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan"
      ],
      "name": "Chi-Yi Chen"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan",
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan",
        "Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan",
        "TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan",
        "Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan"
      ],
      "name": "Wei-Yu Kao"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Taipei City Hospital, Renai Branch, Taipei, Taiwan"
      ],
      "name": "Chih-Lin Lin"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kuan Tien General Hospital, Taichung, Taiwan",
        "Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan",
        "Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan"
      ],
      "name": "Sheng-Shun Yang"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan"
      ],
      "name": "Yu-Lueng Shih"
    },
    {
      "affiliations": [
        "Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan",
        "School of Medicine, China Medical University, Taichung, Taiwan"
      ],
      "name": "Cheng-Yuan Peng"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan"
      ],
      "name": "Fu-Jen Lee"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan",
        "School of Medicine, Chung Shan Medical University, Taichung, Taiwan"
      ],
      "name": "Ming-Chang Tsai"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan"
      ],
      "name": "Shang-Chin Huang"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan",
        "Department of Medical Research, National Taiwan University Biomedical Park Hospital, Hsinchu, Taiwan"
      ],
      "name": "Tung-Hung Su"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan",
        "Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan"
      ],
      "name": "Tai-Chung Tseng"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan",
        "Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan"
      ],
      "name": "Chun-Jen Liu"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan",
        "Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan"
      ],
      "name": "Pei-Jer Chen"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan",
        "Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan",
        "Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan"
      ],
      "name": "Jia-Horng Kao"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan",
        "Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan"
      ],
      "name": "Chen-Hua Liu"
    }
  ],
  "title": "Steatosis grade and cardiometabolic burden as determinants of hepatocellular carcinoma risk after hepatitis C cure in patients with metabolic dysfunction-associated steatotic liver disease",
  "uid": "495bb8f5-645b-5156-ac91-7452a12ca4e5"
}