Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the general population and is the fastest growing cause of hepatocellular carcinoma (HCC). Current guidelines recommend HCC surveillance in patients with cirrhosis when annual HCC incidence exceeds 1% without specifying the role of non-invasive tests in patient selection.
Objective: To define non-invasive test thresholds to select patients with MASLD for HCC surveillance.
Design: A multicentre longitudinal study of adults with MASLD from 16 tertiary centres in the USA, Europe and Asia between February 2004 and January 2023. Primary outcome was incident HCC.
Results: 12 950 patients had Fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) (mean age 51.7 years; 41.1% male). At a median follow-up of 47.7 (IQR 23.3-72.3) months, 109 (0.8%) developed HCC. FIB-4 was below the low cut-off (<1.3 if aged <65 years and <2.0 if aged ≥65 years), between the low cut-off and <2.67, 2.67 to <3.25, and ≥3.25 in 66.3%, 23.9%, 3.4% and 6.4% of patients; the corresponding annual HCC incidence was 0.07%, 0.17%, 0.77% and 1.18%. As a stand-alone test, the annual HCC incidence exceeded 0.2% for LSM ≥10 kPa and 1% for LSM ≥20 kPa. If LSM was performed as a second step only among patients with FIB-4 above the low cut-off, the annual HCC incidence exceeded 0.2% for LSM ≥10 kPa and 1% for LSM ≥15 kPa.
Conclusion: HCC surveillance should be offered to patients with MASLD with FIB-4 ≥3.25 or LSM ≥20 kPa. When a two-step approach is adopted, LSM ≥15 kPa in patients with increased FIB-4 predicts a high HCC risk.
Author
Lai, Jimmy Che-To
Yang, Boyu
Lee, Hye Won
Lin, Huapeng
Tsochatzis, Emmanuel A
Petta, Salvatore
Bugianesi, Elisabetta
Yoneda, Masato
Zheng, Ming-Hua
Hagström, Hannes
Boursier, Jerome
Calleja, Jose Luis
Goh, George Boon-Bee
Chan, Wah-Kheong
Gallego-Duràn, Rocìo
Sanyal, Arun J
de Lédinghen, Victor
Newsome, Philip Noel
Fan, Jian-Gao
Castera, Laurent
Lai, Michelle
Fournier-Poizat, Céline
Wong, Grace Lai-Hung
Pennisi, Grazia
Armandi, Angelo
Nakajima, Atsushi
Liu, Wen-Yue
Shang, Ying
Saint-Loup, Marc de
Llop, Elba
Teh, Kevin Kim Jun
Lara-Romero, Carmen
Asgharpour, Amon
Mahgoub, Sara
Chan, Mandy Sau-Wai
Canivet, Clemence M
Romero-Gómez, Manuel
Kim, Seung Up
Wong, Vincent Wai-Sun
Yip, Terry Cheuk-Fung
Yang, Boyu
Lee, Hye Won
Lin, Huapeng
Tsochatzis, Emmanuel A
Petta, Salvatore
Bugianesi, Elisabetta
Yoneda, Masato
Zheng, Ming-Hua
Hagström, Hannes
Boursier, Jerome
Calleja, Jose Luis
Goh, George Boon-Bee
Chan, Wah-Kheong
Gallego-Duràn, Rocìo
Sanyal, Arun J
de Lédinghen, Victor
Newsome, Philip Noel
Fan, Jian-Gao
Castera, Laurent
Lai, Michelle
Fournier-Poizat, Céline
Wong, Grace Lai-Hung
Pennisi, Grazia
Armandi, Angelo
Nakajima, Atsushi
Liu, Wen-Yue
Shang, Ying
Saint-Loup, Marc de
Llop, Elba
Teh, Kevin Kim Jun
Lara-Romero, Carmen
Asgharpour, Amon
Mahgoub, Sara
Chan, Mandy Sau-Wai
Canivet, Clemence M
Romero-Gómez, Manuel
Kim, Seung Up
Wong, Vincent Wai-Sun
Yip, Terry Cheuk-Fung
Date
2025-06-20
Type
Article
Subject
Gastroenterology, Oncology. Pathology.
Collections
Citation
Lai JC, Yang B, Lee HW, Lin H, Tsochatzis EA, Petta S, Bugianesi E, Yoneda M, Zheng MH, Hagström H, Boursier J, Calleja JL, Goh GB, Chan WK, Gallego-Duràn R, Sanyal AJ, de Lédinghen V, Newsome PN, Fan JG, Castera L, Lai M, Fournier-Poizat C, Wong GL, Pennisi G, Armandi A, Nakajima A, Liu WY, Shang Y, Saint-Loup M, Llop E, Teh KKJ, Lara-Romero C, Asgharpour A, Mahgoub S, Chan MS, Canivet CM, Romero-Gómez M, Kim SU, Wong VW, Yip TC. Non-invasive risk-based surveillance of hepatocellular carcinoma in patients with metabolic dysfunction-associated steatotic liver disease. Gut. 2025 Nov 10;74(12):2050-2057. doi: 10.1136/gutjnl-2025-334981.
Journal / Source Title
Gut
DOI
10.1136/gutjnl-2025-334981
PMID
40541300
Publisher
British Medical Association
Publisher’s URL
https://gut.bmj.com/