Impact of Metabolic Dysfunction-Associated Fatty Liver Disease on the Prognosis of Patients With Hepatocellular Carcinoma After Radical Resection: A Retrospective Study

Introduction Although metabolic dysfunction-associated fatty liver disease (MAFLD) is becoming more common in individuals with hepatocellular carcinoma (HCC), it is still unknown how this condition relates to postoperative complications of HCC. While hepatitis B/C virus (HBV/HCV) infection and alcohol use are primary risk factors, MAFLD has emerged as a significant contributor to HCC incidence. Understanding the prognostic impact of MAFLD on HCC outcomes, particularly post-radical resection, is essential. Objective This study aims to evaluate the prognostic significance of MAFLD on postoperative outcomes in HCC patients, following radical hepatectomy, with a focus on gender-specific mortality differences. Methodology A retrospective cohort study was conducted at Pakistan Navy Station Shifa Hospital, Bahria University Medical and Dental College, Karachi, Pakistan. Consecutive HCC patients who underwent radical resection between May 2023 and April 2024 were included. MAFLD was diagnosed based on hepatic steatosis and metabolic dysfunction criteria. Data on demographics, clinical features, and outcomes were collected from electronic medical records. The primary outcome was overall survival (OS), and the secondary outcomes included recurrence-free survival (RFS). Statistical analyses involved multivariate Cox regression and Kaplan-Meier survival curves using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, NY, USA). Results MAFLD patients exhibited higher median body mass index (BMI) (25.3 kg/m² vs. 23.5 kg/m², p < 0.001), increased prevalence of type 2 diabetes mellitus (33.0% vs. 12.0%, p = 0.019), greater metabolic dysregulation (63.0% vs. 17.0%, p < 0.001), and elevated alanine aminotransferase (ALT) levels (38.0 IU/L vs. 32.0 IU/L, p = 0.045) compared to non-MAFLD patients. While OS and RFS rates were marginally better in the MAFLD group, differences were not statistically significant (p > 0.05). Notably, MAFLD significantly increased mortality in female HCC patients, but not in males. Significant predictors of progression included Child-Pugh grade B, tumour size, and microvascular invasion. Conclusion MAFLD does not significantly impact OS or RFS following radical resection of HCC. However, MAFLD is associated with increased mortality in female patients, highlighting the need for gender-specific monitoring and management strategies in MAFLD-related HCC cases. Further large-scale studies are required to confirm these findings and elucidate the underlying mechanisms.