Association of concomitant MASLD and hepatitis B virus with clinical prognosis in hepatocellular carcinoma after curative resection

The term "metabolic dysfunction-associated steatotic liver disease" (MASLD) was introduced to replace the term "nonalcoholic fatty liver disease". The prevalence of MASLD is increasing worldwide. The prevalence of concomitant MASLD and hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) is also increasing. This study explored the effect of the coexistence of MASLD and HBV on clinicopathological features and long-term clinical prognoses in patients with MASLD-related and/or HBV-related HCC after curative hepatectomy. The study retrospectively collected the data of 653 patients with HCC who had undergone curative hepatectomy between 2011 and 2022. We assessed the association of histologically confirmed MASLD with HCC recurrence and mortality. Of 653 patients, 320 (49.0%), 103 (15.8%), and 230 (35.2%) had concomitant MASLD and HBV, MASLD only, and HBV only, respectively. The median follow-up period was 5.1 years. Patients with concomitant MASLD and HBV were at a significantly increased risk of HCC recurrence (P = 0.013 and P = 0.041) and mortality (P = 0.044 and P = 0.026) than those with MASLD or HBV alone. In multivariable analyses, concomitant MASLD and HBV, male sex, body mass index < 23, absence of antiviral therapy, and tumor size >= 5 cm were significantly associated with increased HCC recurrence. Concomitant MASLD and HBV, male sex, type 2 diabetes mellitus, serum aspartate aminotransferase >= 40 U/L, tumor size >= 5 cm, tumor cell differentiation II-III, microvascular invasion, lymph node invasion, and tumor recurrence were significantly associated with increased mortality. In conclusion, patients with concomitant MASLD and HBV are at a significantly greater risk of HCC recurrence and mortality after curative hepatectomy than those with MASLD or HBV alone.