Hepatocellular carcinoma risk in metabolic dysfunction-associated steatotic liver disease with increased alcohol intake (MetALD)

Limited data exist on the risk of hepatocellular carcinoma (HCC) in patients with MetALD (metabolic dysfunction-associated steatotic liver disease [MASLD] with increased alcohol consumption) and how it compares with other steatotic liver diseases. In this retrospective study of 666,428 patients from the Veterans Analysis of Liver Disease cohort, we observed that the risk of HCC per 100,000 person-years in patients without cirrhosis with MetALD was 80.24 (95% CI 73.23-87.94), which was intermediate between MASLD (71.64, 95% CI 68.14-75.32) and ALD (104.83, 91.59-119.98). The cumulative incidence of HCC per 100,000 persons at 5 years was the highest with ALD (663.79, 581.77-754.83), followed by MASLD (450.71, 428.46-473.89), MetALD (449.89, 407.56-495.74), and controls (76.03, 61.47-93.46). The limitations of the study include its retrospective design and a study population enriched with male veterans with a higher prevalence of metabolic syndrome.