Incidence of Hepatocellular Carcinoma in MASLD Patients Quantified in Large Meta-Analysis
A large meta-analysis of reconstructed individual patient data published in Clinical Gastroenterology and Hepatology provides updated estimates of hepatocellular carcinoma (HCC) incidence among patients with metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD, now the fastest-rising cause of HCC, previously lacked time-dependent risk estimates.
Researchers screened 4951 articles and analyzed 26 studies including nearly 4 million individuals. Using reconstructed Kaplan–Meier curves, the pooled cumulative incidence of HCC was assessed across both administrative databases and hospital/clinic-based cohorts. The results reveal significant differences in risk depending on fibrosis status and data source.
In patients with MASLD and advanced fibrosis, the 1-, 3-, 5-, and 10-year cumulative HCC incidence was 0.8%, 2.4%, 3.9%, and 8.8%, respectively, in administrative database studies, compared with substantially higher rates of 3.9%, 11.7%, 21.0%, and 48.5% in hospital/clinic-based studies. For MASLD patients without advanced fibrosis, the corresponding 10-year risks were markedly lower: 1.3% in administrative data and 18.3% in hospital/clinic-based cohorts.
The investigators emphasized that selection bias likely contributes to the higher incidence observed in hospital and clinic-based studies. Nonetheless, both analytic approaches consistently demonstrated a strong association between advanced fibrosis and increased HCC risk. Hazard ratios confirmed this elevated risk, with advanced fibrosis conferring more than a 10-fold increase in both administrative (HR 11.09; 95% CI, 2.68–45.89; p<0.001) and hospital/clinic-based analyses (HR 10.50; 95% CI, 3.19–34.51; p<0.001).
This large-scale analysis underscores the importance of fibrosis stage in determining HCC surveillance strategies among MASLD patients. The findings suggest that individuals with advanced fibrosis represent a high-risk group requiring vigilant monitoring, while also highlighting the need for further refinement of surveillance algorithms to balance resource allocation with clinical benefit.
Reference:
Lim RY, Tan FXN, Ho GJK, et al. Incidence of hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease: A reconstructed individual patient data meta-analysis. Clin Gastroenterol Hepatol. Published online September 9, 2025.
