MASLD-related HCC: Multicenter study comparing patients with and without cirrhosis
Carole Vitellius,
Elvire Desjonqueres,
Marie Lequoy,
Giuliana Amaddeo,
Isabelle Fouchard,
Gisele N’Kontchou,
Clemence M. Canivet,
Marianne Ziol,
Hélène Regnault,
Adrien Lannes,
Frederic Oberti,
Jerome Boursier,
Nathalie Ganne-Carrie
Affiliations
Carole Vitellius
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France; Corresponding author. Address: Dr Carole Vitellius; Service d'Hépato-Gastroentérologie, CHU 49933 Angers Cedex 09, France; Tel.: (33) 2 41 35 34 10, fax: (33) 2 41 35 41 19.
Elvire Desjonqueres
Service d'Hépatologie et Oncologie hépatique, AP-HP Sorbonne Paris Nord, Hôpital Universitaire Avicenne, Bobigny, France
Marie Lequoy
Service d’Hépatologie, AP-HP Saint-Antoine, France
Giuliana Amaddeo
Service d’Hépatologie, AP-HP Henri Mondor, Créteil, France
Isabelle Fouchard
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France
Gisele N’Kontchou
Service d'Hépatologie et Oncologie hépatique, AP-HP Sorbonne Paris Nord, Hôpital Universitaire Avicenne, Bobigny, France
Clemence M. Canivet
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France
Marianne Ziol
Service d'Anatomie et de Cytologie Pathologiques, APHP Sorbonne Paris Nord, Hôpital Universitaire Avicenne, Bobigny, France; Centre de recherche des Cordeliers, Sorbonne Université, Inserm UMR-1162, Université de Paris, team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006 Paris, France
Hélène Regnault
Service d’Hépatologie, AP-HP Henri Mondor, Créteil, France
Adrien Lannes
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France
Frederic Oberti
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France
Jerome Boursier
Service d’Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d’Angers, Angers, France; Laboratoire HIFIH UPRES EA3859, SFR 4208, Université d’Angers, Angers, France
Nathalie Ganne-Carrie
Service d'Hépatologie et Oncologie hépatique, AP-HP Sorbonne Paris Nord, Hôpital Universitaire Avicenne, Bobigny, France; Centre de recherche des Cordeliers, Sorbonne Université, Inserm UMR-1162, Université de Paris, team «Functional Genomics of Solid Tumors», Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, F-75006 Paris, France
Background & Aims: Despite its growing incidence, hepatocellular carcinoma (HCC) related to metabolic dysfunction-associated steatotic liver disease (MASLD) in non-cirrhotic livers remains poorly characterized. We compared the characteristics, management, survival, and trends of MASLD-related HCC in patients with or without underlying cirrhosis in a large multicenter cohort. Methods: A total of 354 cases of MASLD-related HCC presented at the liver tumor meetings of four French university hospitals between 2007 and 2018 were included in the study. Data were extracted from the meetings’ databases and from the French Birth and Death Registry. Results: Of HCC cases, 35% occurred in the absence of cirrhosis. HCC was diagnosed through screening in 60% of patients with cirrhosis, and incidentally in 72% of patients without it. Patients without cirrhosis were older, had a greater tumor burden, but also better liver function than patients with cirrhosis. Patients without cirrhosis showed better overall survival than those with cirrhosis (p = 0.043). However, cirrhosis was not independently associated with overall survival, the independent predictors were age, liver function, tumor burden and BCLC classification. Patients without cirrhosis underwent surgery more frequently than patients with cirrhosis (41% vs. 11%, p <0.001), even in cases where the largest tumors were ≥5 cm (42% vs. 14%, p = 0.002) or there were four or more lesions (19% vs. 2%, p = 0.024). Among the patients (with/without cirrhosis) who underwent surgery, survival was not significantly different. The cirrhosis/no cirrhosis ratio remained stable over the study period. Conclusions: In MASLD-related HCC, patients without cirrhosis account for 35% of cases and have poor prognostic factors (higher age and larger tumors) but also better liver function, resulting in more aggressive management of advanced tumors and better survival compared to patients with cirrhosis. Impact and implications:: The incidence of hepatocellular carcinoma (HCC) related to metabolic dysfunction-associated steatotic liver disease (MASLD) is projected to increase by 47% to 130% by year 2030 with one-third of cases occurring in non-cirrhotic livers, making them inaccessible to screening and therefore more likely to be diagnosed at an advanced stage. Our study shows that survival in patients with MASLD-related HCC depends on age, tumor burden and underlying liver function and the preserved liver function of these non-cirrhotic patients allows them to be managed surgically. A better understanding of the pathophysiological processes driving HCC occurrence in patients with non-cirrhotic MASLD will help guide the screening and early management of these patients.
