ArticleJournal of gastroenterology and hepatology2026
Risk of HCC in Elderly Patients With MASLD: Proposal of an Effective Surveillance Strategy.
Article in Journal of gastroenterology and hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent among aging populations.
objectiveWe evaluated hepatocellular carcinoma (HCC) risk across MASLD spectrum in this population and developed a nomogram to guide optimized surveillance.
methodsUsing a nationwide South Korean database, we identified participants aged ≥ 75 years undergoing health screening between 2012 and 2015. Steatotic liver disease (SLD) was classified as MASLD, MetALD (MASLD with increased alcohol intake), or alcohol-associated liver disease (ALD). Competing-risk regression for HCC risk was used to estimate adjusted subdistribution hazard ratios (a-sHRs) by SLD subtype, using Fine-Gray models.
resultsAmong 1 088 314 participants, 34.3% had SLD (351 583 MASLD; 11 586 MetALD; 9619 ALD). The overall 5-year HCC incidence in the SLD group (0.769%) was higher compared with the non-SLD group (0.334%). It increased stepwise from MASLD (0.687%) to MetALD (1.856%) and ALD (2.443%): a-sHRs of 1.93, 2.99, and 4.35, respectively. Stratified analyses consistently demonstrated the same pattern. A nomogram incorporating age, sex, smoking, diabetes, statin use, SLD subtype, gamma-glutamyl transferase, body mass index, liver cirrhosis, and aspartate transaminase/alanine transaminase ratio was developed, with good discriminative ability. Scores of < 103 (87.7% of participants) corresponded to an annual HCC risk of < 0.2%, suggesting exemption from HCC screening, whereas scores of > 171 (0.14%) corresponded to an annual risk of > 1%, indicating the need for continuous screening.
conclusionsElderly individuals with MASLD spectrum exhibit a significant HCC risk, with higher risk in MetALD and ALD groups. Given the very small proportion who require HCC screening, our nomogram serves as a practical tool for community-based risk stratification and optimized surveillance.
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