METABOLIC DYSFUNCTION-associated steatotic liver disease (MASLD) was not associated with a statistically significant overall survival difference after matching patients undergoing surgery for hepatitis B-related liver cancer, a multicentre study has found.
Although unadjusted results suggested better outcomes with MASLD, that advantage did not remain statistically significant after balancing selected baseline characteristics. Subgroup findings suggested that body mass index (BMI) may help explain some of the variation.
Researchers retrospectively assessed 424 patients with chronic hepatitis B-related hepatocellular carcinoma (HCC) who underwent hepatectomy at three tertiary centres in China between January 2018 and June 2025.
Patients with both MASLD and hepatitis B-related HCC were compared with those who had hepatitis B-related HCC without MASLD. A separate meta-analysis included eight studies involving 6,653 patients, all from Asian populations.
During a median follow-up of 38.5 months in the primary cohort, 144 patients died. Before matching, the MASLD group had better overall survival and recurrence-free survival, with p values of 0.041 and 0.028, respectively.
Propensity score matching produced 169 patient pairs. Following this adjustment, neither overall survival nor recurrence-free survival differed significantly between groups (p=0.220 and p=0.190, respectively). The authors reported that this overall finding was consistent with their meta-analysis.
The results illustrate why an apparent survival advantage in an observational cohort needs careful adjustment. Differences in disease severity, tumour characteristics and other prognostic factors can influence comparisons between patients with and without an additional liver condition.
Higher BMI remained associated with favourable survival in multivariable analyses. In subgroup analyses using BMI thresholds of 23 kg/m² and 25 kg/m², patients with MASLD in the higher-BMI groups had better overall and recurrence-free survival than those without MASLD.
However, early postoperative outcomes complicate any suggestion of a protective effect. Thirty-day mortality was higher in the MASLD group overall, and all seven deaths within 30 days occurred in patients with BMI below 23 kg/m².
The findings support further investigation of how metabolic status and body composition relate to surgical prognosis. They do not establish that MASLD or weight gain improves cancer outcomes.
The retrospective design, differences in MASLD definitions and exclusively Asian meta-analysis populations limit interpretation. Larger prospective studies are needed to validate the BMI-related findings before they can support changes to postoperative risk assessment or management.
Reference
Chen Y et al. A comprehensive evaluation on the impact of MASLD on the prognosis of chronic hepatitis B-related hepatocellular carcinoma following hepatectomy: results from retrospective multicenter cohort study and meta-analysis. Hepatol Int. 2026;DOI:10.1007/s12072-026-11151-y.
Featured image: Pormezz on AdobeStock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
