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

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. 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. 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 7,383 postoperative HCC patients (2,192 with MAFLD/MASLD and 5,191 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). 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.