Association of steatotic liver disease with long-term oncological outcomes after hepatic resection for hepatocellular carcinoma

Abstract

Hepatic steatosis manifests in obesity and systemic metabolic disorders. The nomenclature has recently shifted from nonalcoholic fatty liver disease/nonalcoholic steatohepatitis to steatotic liver disease (SLD), which includes metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatotic liver disease with increased alcohol intake, and alcohol-related liver disease. This study retrospectively evaluated the association between SLD and long-term oncological outcomes in 85 patients undergoing hepatic resection for hepatocellular carcinoma (HCC) between 2018 and 2022. SLD was histologically defined as steatosis involving ≥ 5% of non-tumorous hepatocytes. Of these patients, 47 did not have SLD (non-SLD group) and 38 had SLD. We compared recurrence-free survival (RFS) and overall survival (OS) between these groups. Patients with SLD exhibited a higher body mass index and more advanced fibrosis than those without SLD, whereas lifestyle-related diseases were comparably prevalent. Median RFS was not reached in the non-SLD group and was 21 months in the SLD group (log-rank p = 0.054). In exploratory multivariable analysis, SLD was associated with a higher cause-specific hazard of recurrence after adjustment for age, Barcelona Clinic Liver Cancer stage, viral hepatitis status, and diabetes mellitus (adjusted hazard ratio, 1.939; 95% confidence interval, 1.003–3.748). No significant association between SLD and OS was noted (hazard ratio, 0.962; 95% confidence interval, 0.399–2.315). These findings suggest a possible association between SLD and HCC recurrence after hepatic resection, whereas its association with OS remains uncertain.