Impact of metabolic dysfunction-associated fatty liver disease on survival outcomes in patients undergoing radical resection for hepatitis B virus-related hepatocellular carcinoma

Background & Aims: The prevalence of concomitant metabolic dysfunction-associated fatty liver disease (MAFLD) in patients with hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC) is increasing, though the relationship between MAFLD and HBV-HCC remains unclear. The aim of this study is to evaluate the clinical impact of MAFLD on survival outcomes in patients with HBV-HCC after radical resection. Methods Patients with HBV-HCC who underwent radical resection consecutively from January 2015 to December 2020 were included. The retrospective analysis focused on the correlation between histologically confirmed concomitant MAFLD and clinical outcomes. Results Among the 843 patients with HBV-HCC who underwent radical resection, concomitant MAFLD was observed in 172 (20.4%) patients. In comparison to the non-MAFLD group, the MAFLD group did not have a significant impact on recurrence-free survival (RFS) or overall survival (OS) rates at 1-, 3-, and 5-years (all P  > 0.05). However, subgroup analysis revealed significantly lower 1-, 3-, and 5-year rates of RFS and OS in the diabetic MAFLD group compared to the non-diabetic MAFLD group (all P  < 0.05). Moreover, diabetic MAFLD was an independent risk factor associated with poorer OS after radical resection (HR, 1.444; 95% CI, 1.082–2.331, P  = 0.032). Conclusions Concomitant diabetic MAFLD is associated with a poor prognosis after radical resection in patients with HBV-HCC.