Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is now the fastest-growing cause of hepatocellular carcinoma (HCC). Because a substantial proportion of MASLD-related HCC develops before cirrhosis, better tools are needed to identify high-risk patients who may benefit from surveillance.
Introduction:
Metabolic dysfunction–associated steatotic liver disease (MASLD) is now the fastest-growing cause of hepatocellular carcinoma (HCC). Because a substantial proportion of MASLD-related HCC develops before cirrhosis, better tools are needed to identify high-risk patients who may benefit from surveillance. This study evaluated whether liver stiffness measurement (LSM) by transient elastography can improve HCC risk stratification in MASLD.
Why was this study needed?
HCC increasingly develops in patients with MASLD, including those without cirrhosis.
Current surveillance strategies miss many high-risk noncirrhotic patients.
Reliable, noninvasive biomarkers for HCC risk stratification are lacking.
Defining LSM thresholds could enable more cost-effective surveillance.
Results:
This retrospective study included more than 30,000 patients with MASLD from the Veterans Analysis of Liver Disease (VALID) cohort. HCC risk increased progressively with increasing liver stiffness, with every 5 kPa rise in LSM associated with an 18% increase in HCC risk. Patients with higher LSM values demonstrated stepwise increases in annual HCC incidence, reaching nearly 1% per year among those with LSM ≥25 kPa. Importantly, among patients without cirrhosis or clinically significant portal hypertension, those with diabetes and an LSM ≥10 kPa had an annual HCC incidence exceeding the accepted threshold for cost-effective HCC surveillance.
Clinical Impact:
LSM may become an important noninvasive tool for individualized HCC surveillance in MASLD. Rather than relying solely on cirrhosis status, integrating liver stiffness and diabetes status could identify high-risk noncirrhotic patients who are currently overlooked by existing surveillance recommendations. This approach may improve early HCC detection while optimizing resource utilization.
Bottom Line:
Liver stiffness is a strong predictor of HCC risk in MASLD. Noncirrhotic patients with MASLD, diabetes, and an LSM ≥10 kPa may be appropriate candidates for HCC surveillance.
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