Severance Hospital Research Team Led by Professors Kim Seungup and Lee Hyewon
Demonstrates Effectiveness of a Two-Step Non-Invasive Strategy
for Predicting Liver Cancer Risk in MASLD Patients
A recent study has found that the risk of liver cancer in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) can be predicted using a non-invasive strategy.
A research team led by Professors Kim Seungup and Lee Hyewon at the Liver Center of Severance Hospital, in collaboration with the Chinese University of Hong Kong and 16 institutions across the United States, Europe, and Asia, announced on August 11 that they have demonstrated the clinical effectiveness of a two-step non-invasive assessment strategy for measuring the risk of hepatocellular carcinoma in patients with MASLD.
The results of this study were published in the latest issue of the international journal Gut (IF 25.8).
MASLD is a disease in which fat accumulates in the liver even in people who drink little or no alcohol. It is a very common condition, affecting about 30% of the global population. Previously referred to as "non-alcoholic fatty liver disease (NAFLD)," it is now being redefined as "metabolic dysfunction-associated steatotic liver disease" due to its close association with metabolic disorders such as diabetes, hypertension, and obesity.
The research team validated a model that can identify patients at high risk of developing severe complications, including liver cancer, using non-invasive methods. According to the guidelines of the American Association for the Study of Liver Diseases, they first calculated the fibrosis marker "FIB-4" through a blood test, and then applied a two-step strategy by additionally performing vibration-controlled transient elastography (VCTE) to measure liver stiffness.
After following a total of 12,950 MASLD patients for an average of 47 months, the study found that patients with a FIB-4 score of 3.25 or higher, or those with a liver stiffness measurement of 20 kPa or higher by VCTE, had an annual liver cancer incidence rate exceeding 1%, meeting the criteria for surveillance. In addition, patients with a high FIB-4 score and liver stiffness of 15 kPa or higher were classified as a high-risk group, regardless of the presence of cirrhosis.
In contrast, when the FIB-4 score was high but liver stiffness was low, the three-year incidence of liver cancer was found to be less than 0.3%, indicating that these patients could potentially be excluded from surveillance.
This strategy achieved an AUROC of 0.733, a positive predictive value of 7.9%, a negative predictive value of 99.7%, and an overall accuracy of over 93%, demonstrating high clinical reliability.
Professor Kim Seungup stated, "This study is significant in that it presents a practical and simple clinical strategy for predicting disease progression in MASLD patients. The two-step approach can be applied regardless of the presence of cirrhosis, thus addressing the limitations of existing liver cancer surveillance strategies."
Professor Lee Hyewon added, "Considering that liver cancer can develop in MASLD patients even without cirrhosis, this strategy is expected to make a substantial contribution to establishing patient-tailored surveillance systems. The validated approach allows for precise identification of high-risk patients while excluding low-risk patients from unnecessary testing."
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