Hepatocellular Carcinoma Risk Increases Stepwise from MASLD to ALD

A new large-scale cohort study published in The American Journal of Gastroenterology from the Republic of Korea highlights the progressive increase in hepatocellular carcinoma (HCC) risk across metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with moderate alcohol consumption (MetALD), and alcohol-associated liver disease (ALD).

Analyzing data from over 6.4 million individuals aged 40 to 79 years, the researchers found a clear stepwise increase in HCC incidence. Compared with individuals without MASLD, the adjusted hazard ratios (aHRs) for HCC were 1.66 for MASLD, 2.17 for MetALD, and 2.34 for ALD.

“Among the older, female, and cirrhosis subgroups, MetALD poses similar HCC risks as ALD,” the authors noted, suggesting that even moderate alcohol intake can significantly impact risk in certain populations. 

The study’s median follow-up of 13.3 years strengthens the evidence for long-term risk assessment. Particularly concerning is the vulnerability of older individuals and those without preexisting cirrhosis, in whom MASLD and alcohol intake had a more pronounced effect.

“For an effective primary prevention of HCC, a comprehensive approach should be required to modify both metabolic dysfunction and alcohol intake habit,” the authors concluded. 

For gastroenterologists, these findings reinforce the importance of routine HCC risk assessment in MASLD patients and highlight the need for targeted counseling on alcohol consumption, even at moderate levels. 

Reference
Yun B, Park H, Ahn SH, Oh J, Kim BK, Yoon JH. Liver cancer risk across metabolic dysfunction-associated steatotic liver disease and/or alcohol: a nationwide study. Am J Gastroenterol. Published online February 1, 2025. doi: 10.14309/ajg.0000000000002920.