Metabolic dysfunction-associated steatotic liver disease increases hepatocellular carcinoma risk in chronic hepatitis B patients: a retrospective cohort study

When Metabolic Dysfunction-Associated Steatotic Liver Disease Meets Viral Hepatitis

The interplay between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and viral hepatitis, primarily hepatitis B virus (HBV) and hepatitis C virus (HCV), presents a complex challenge in managing chronic liver diseases. Recent epidemiological insights suggest an escalating prevalence of MASLD globally, attributed mainly to the obesity epidemic and associated metabolic disorders. Concurrently, chronic viral hepatitis remains a significant contributor to liver disease morbidity and mortality worldwide, despite advances in antiviral therapies. According to the World Health Organization (WHO) 2023 data, approximately 296 million people are living with chronic HBV infection (about 3.8% of the global population), and 58 million people with HCV infection (about 0.7%), together accounting for over 1.1 million deaths annually. The coexistence of MASLD and viral hepatitis presents a complex scenario in clinical outcomes, where the effects on liver health can vary. Although many studies highlight the potential for additive or synergistic worsening of liver conditions, leading to complications such as cirrhosis, liver failure, and HCC, the impact of HBV on MASLD is not consistent. Managing patients with dual MASLD and viral hepatitis is complex due to the interplay of metabolic and viral factors. Lifestyle modifications, including weight loss, dietary changes, and physical activity, are fundamental to MASLD management and help reduce fibrosis risk in viral hepatitis. This review examines the dual impact of MASLD and viral hepatitis on liver pathology and delineates shared pathophysiological mechanisms, including the influence on hepatic steatosis, inflammation, and fibrogenesis. It also discusses therapeutic strategies tailored to manage this comorbidity, emphasizing the need for an integrated care approach that addresses both metabolic dysfunctions and viral infection to optimize patient outcomes.

A comprehensive analysis of percutaneous liver biopsy characteristics and pathological manifestations in a large patient cohort (2009-2024)

OBJECTIVE

This study aimed to analyze the characteristics of patients undergoing percutaneous liver biopsies and investigate the pathological manifestations of four major liver diseases across different age groups.

METHODS

A retrospective analysis was conducted of 4,717 liver pathology reports from 2009 to 2024. The study population comprised 4,188 patients who underwent liver biopsies, with 408 patients receiving two biopsies and 50 patients who underwent three or more procedures. Most of biopsies (4,171) were performed between 2013 and 2023. Disease categorization, temporal distribution, and pathological manifestations across different age groups were assessed employed descriptive statistics, trend analyses, and graphical representations.

RESULTS

Since 2020, a gradual increase has been observed in the proportion of cases involving concurrent hepatitis B complicated by metabolic-associated steatohepatitis (MASLD), along with an elevation in the incidence of MASLD alone. Pathological manifestations varied considerably across different age groups. Patients with hepatitis B complicated by MASLD exhibited disease exacerbation in middle age, with both liver inflammation and fibrosis grading worsening as age advanced. Furthermore, within the same age bracket, the severity of inflammation and the extent of fibrosis were more pronounced in cases where chronic hepatitis B was combined with MASLD compared to those with isolated chronic hepatitis B or MASLD.

CONCLUSION

This study offers a comprehensive analysis of the characteristics and pathological manifestations of patients who underwent percutaneous liver biopsies over a 15-year period. The findings underscore the varying pathological manifestations across different age groups for the four major liver diseases and emphasize the necessity for tailored therapeutic interventions, particularly for patients with concurrent hepatitis B and MASLD, as antiviral therapy alone may be inadequate. Further research is warranted to explore optimal management strategies for these patient subpopulations.

Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B

Chronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting about one-third of CHB patients. The interaction between hepatic steatosis and CHB-related disease progression is complex and still under debate. Evidence demonstrates that co-existing steatosis may worsen liver fibrosis while paradoxically increasing the likelihood of achieving better HBV control. In particular, despite the association of steatotic liver disease (SLD) with lower HBV viral loads and higher rates of HBsAg seroclearance, the coexistence of CHB and SLD can potentially accelerate liver disease progression. Factors such as fat deposition, lipotoxicity, oxidative stress, and chronic inflammation in SLD may foster a pro-fibrotic and pro-carcinogenic environment, accelerating the disease progression. Additionally, loss of global DNA methylation, changes in the immune microenvironment, and genetic susceptibility further contribute to the development of CHB-related cirrhosis and hepatocellular carcinoma (HCC). This review examines the mechanisms driving liver disease progression and the heightened risk of cirrhosis and HCC in patients with concurrent CHB and steatotic liver disease, underscoring the importance of prioritizing antiviral therapy for CHB in addition to addressing SLD.

Hepatitis B virus infection and metabolic dysfunction associated steatotic liver disease: Rising pandemic with complex interaction

Due to sedentary lifestyle and rising prevalence of obesity, patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disease (MASLD). Both chronic hepatitis B virus (HBV) infection and MASLD can damage hepatocytes in their own way, but concomitant HBV-MASLD has its own clinical implications. Cherry on top is the presence of diabetes mellitus, hypertension or obesity which added more chances of unfavorable outcomes in these patients. In this article, we comment on the article by Wang et al published in the recent issue. This article provides a comprehensive overview of the complex interaction between HBV-MASLD, HBV alone and MASLD alone patients. We discuss key findings from recent studies, including the promising outcomes observed in patients with concurrent HBV and MASLD, warrants further research. The insights presented here offer renewed understanding of this complex interaction.

Impact of Metabolic Dysfunction-Associated Fatty/Steatotic Liver Disease on Hepatocellular Carcinoma Incidence and Long-Term Prognosis Post-Liver Resection: A Systematic Review and Meta-Analysis

BACKGROUND

This study investigates the influence of metabolic dysfunction-associated fatty liver disease (MAFLD)/metabolic dysfunction-associated steatotic liver disease (MASLD) on the incidence of hepatocellular carcinoma (HCC) among general population and patients with chronic hepatitis B (CHB). It also explores its implications for the long-term prognosis of HCC patients following hepatic resection.

METHODS

Relevant studies were selected based on predefined inclusion and exclusion criteria, including adherence to diagnostic criteria for MAFLD/MASLD and reporting hazard ratios (HRs) using Cox proportional hazards models. The meta-analysis utilized R statistical software (version 4.3.0) with random-effects models to calculate pooled HRs. Sensitivity analyses were performed to ensure the robustness of results.

RESULTS

Our analysis included 19 studies, among which 12 studies focused on the cumulative incidence of HCC in the general population (979,213 individuals; 294,984 with MAFLD/MASLD and 684,229 without). MAFLD/MASLD significantly increased the cumulative incidence of HCC in the general population (HR = 1.82; 95% CI, 1.34-2.48). In CHB patients (316,445 participants; 108,183 with MAFLD/MASLD and 208,262 without), the cumulative incidence of HCC was also higher in the MAFLD/MASLD group (HR = 1.36; 95% CI, 1.32-1.40). For 7383 postoperative HCC patients (2192 with MAFLD/MASLD and 5191 without), MAFLD/MASLD did not significantly affect overall survival (OS) (HR = 0.93; 95% CI, 0.69-1.26) or recurrence-free survival (RFS) (HR = 0.98; 95% CI, 0.86-1.13).

CONCLUSION

In conclusion, MAFLD/MASLD can significantly increase the incidence of HCC in both the general population and CHB patients. However, it does not significantly influence long-term prognosis after hepatic resection, suggesting that other factors may have a greater role in determining postoperative outcomes. This highlights the need for tailored management strategies for MAFLD/MASLD patients undergoing HCC resection.