MAFLD-HCC in Italy: a rapidly increasing prevalence, a reduced cancer aggressiveness?

Non-alcoholic liver disease (NAFLD)’s current nomenclature supports an exclusionary diagnosis, i.e. based on the ruling out of other liver disease causes instead of active case-finding. As an alternative to NAFLD, an international panel of experts has recently proposed a new definition of NAFLD, termed metabolic dysfunction-associated fatty liver disease (MAFLD), based on active identification of its associated metabolic risk factors.
PUBLISHED IN: Gut (December 2021)

Comment:

Non-alcoholic liver disease (NAFLD)’s current nomenclature supports an exclusionary diagnosis, i.e. based on the ruling out of other liver disease causes instead of active case-finding. As an alternative to NAFLD, an international panel of experts has recently proposed a new definition of NAFLD, termed metabolic dysfunction-associated fatty liver disease (MAFLD), based on active identification of its associated metabolic risk factors.
MAFLD is characterised by hepatic steatosis specifically with the presence of NAFLD-associated metabolic dysfunctions. This includes obesity, diabetes mellitus, or two or more manifestations of metabolic dysregulation.

The aim of this study was to evaluate the presence of MAFLD in patients with hepatocellular carcinoma (HCC) by assessing the epidemiological trajectories of MAFLD-associated HCC (MAFLD-HCC) in the Italian Cancer Liver database. In this review, MAFLD-HCC included pure MAFLD-HCC (patients with both HCC and MAFLD, with no additional aetiologies), as well as mixed aetiology MAFLD-HCC (HCC patients with a diagnosis of MAFLD and with other aetiologies).

Non-alcoholic liver disease (NAFLD)’s current nomenclature supports an exclusionary diagnosis, i.e. based on the ruling out of other liver disease causes instead of active case-finding. As an alternative to NAFLD, an international panel of experts has recently proposed a new definition of NAFLD, termed metabolic dysfunction-associated fatty liver disease (MAFLD), based on active identification of its associated metabolic risk factors.
MAFLD is characterised by hepatic steatosis specifically with the presence of NAFLD-associated metabolic dysfunctions. This includes obesity, diabetes mellitus, or two or more manifestations of metabolic dysregulation.

The aim of this study was to evaluate the presence of MAFLD in patients with hepatocellular carcinoma (HCC) by assessing the epidemiological trajectories of MAFLD-associated HCC (MAFLD-HCC) in the Italian Cancer Liver database. In this review, MAFLD-HCC included pure MAFLD-HCC (patients with both HCC and MAFLD, with no additional aetiologies), as well as mixed aetiology MAFLD-HCC (HCC patients with a diagnosis of MAFLD and with other aetiologies).

Key learnings:

MAFLD was diagnosed in the majority of Italian patients with HCC. A significant increase in pure MAFLD-HCC cases between 2002 and 2019 was also found. MAFLD-ACC was further predicted to become the only form of HCC in Italy by the next 10-12 years.
Patients with pure MAFLD-HCC also displayed advanced fibrosis in 90% of cases, and HCC was diagnosed less frequently during surveillance compared to those with mixed aetiology MAFLD-HCC and with non-MAFLD-HCC.
MAFLD was also associated with increased HCC tumour size. However, despite this, patients with MAFLD-HCC possessed a significantly lower risk of death related to HCC progression than patients without MAFLD. As such, MAFLD is associated with a reduction in HCC aggressiveness.

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Dr. S Duarte

Dr. S Duarte

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