Significant predictors of clinical outcomes in metabolic associated fatty liver disease-related hepatocellular carcinoma following hepatectomy

The risk factors for clinical outcomes of hepatocellular carcinoma (HCC) associated with metabolic-associated fatty liver disease (MAFLD) following hepatectomy remain uncertain. The association between aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism and HCC recurrence and mortality remains unknown in this population. This retrospective cohort study enrolled 70 patients with MAFLD-related HCC who underwent hepatectomy between 2011 and 2022 at the E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Data analysis was completed in October 2023. The proposed criteria for the diagnosis of MAFLD are based on the evidence of hepatic steatosis (>5%) and one of the following 3 criteria: overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. The end points were HCC recurrence and overall mortality. Of the 70 patients enrolled, 55 (78.6%) were men, and the mean (standard deviation) age was 67.4 (8.0) years. HCC recurrence occurred in 19 patients, and 20 died. The 10-year cumulative HCC recurrence and mortality rates after resection were 55.4% and 43.9%, respectively. In Cox proportional analyses, patients with ALDH2 rs671 genotypes GA/AA had the highest HCC recurrence rate (hazard ratio [HR]: 3.48, 95% confidence interval [CI]: 1.08-12.4, P = .045), followed by those with multiple tumors (HR: 3.06, 95% CI: 1.11-10.9, P = .039). Moreover, patients with Barcelona clinic liver cancer stage B/C had the highest mortality rate (HR: 3.94, 95% CI: 1.34-11.6, P = .012), followed by those with hypertension (HR, 3.47; 95% CI: 1.28-9.40, P = .015). ALDH2 rs671 polymorphism and multiple liver tumors were strongly associated with HCC recurrence. Furthermore, Barcelona clinic liver cancer stage and hypertension were significantly associated with mortality in MAFLD-related HCC patients after hepatectomy.