Metabolic fatty liver disease: a new red flag for liver cancer

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a new risk factor for liver cancer, prompting experts to call for lifestyle disease management and more aggressive early surveillance strategies for these patients.

On Monday, the Korean Liver Cancer Association (KALC) held a ceremony to commemorate Liver Cancer Day (Feb. 2 every year). The ceremony highlighted the impact of metabolic fatty liver disease on the development of liver cancer and discussed prevention and surveillance strategies.

Professor Lee Dong-hyeon of the Department of Gastroenterology at SMG-SNU Boramae Medical Center, a member of the association’s planning committee, emphasized that metabolic fatty liver disease is associated with a high risk of progression to liver cancer without cirrhosis and has a worse prognosis than liver cancer caused by other major causes, including that caused by viral liver disease.

“Liver cancer that develops from metabolic fatty liver disease has unique clinical features,” Professor Lee said. “Unlike other liver cancers, it often occurs without cirrhosis and is often accompanied by lifestyle diseases. Particularly noteworthy is the low rate of early diagnosis and poor prognosis.”

Lee noted that these characteristics call for a new approach to the management of liver cancer in patients with metabolic fatty liver disease. Patients without cirrhosis should be carefully monitored, and intensive surveillance of patients with lifestyle diseases is required. He added that there is an urgent need for aggressive screening strategies to increase early diagnosis rates and personalized treatment options to improve prognosis.

“Lifestyle modification is the most important factor in reducing the incidence of liver cancer in patients with metabolic fatty liver disease,” Professor Lee said.

He advised avoiding smoking and excessive alcohol consumption, improving metabolic health through proper weight management and exercise, and taking lifestyle disease-treating medications, such as metformin, statins, and aspirin, after consulting a doctor can help lower the risk of liver cancer.

“Active surveillance of high-risk patients with metabolic fatty liver disease is important for early detection of liver cancer,” Lee said. “In particular, it's time to strategize about whether to offer surveillance tests, including routine ultrasound and alpha-fetoprotein testing, to patients who don't have cirrhosis but have additional risk factors, such as advanced liver fibrosis, diabetes, advanced age, and male gender."

Professor Lee continued, “In cases where obesity precludes ultrasound, alternative imaging modalities, including computed tomography (CT) or magnetic resonance imaging (MRI), may also be considered, which should allow for early detection of metabolic fatty liver disease-associated liver cancer and initiation of appropriate treatment.”

According to the association, liver cancer has been on a downward trend in terms of new cases and gross death rate since the early- to mid-2010s. However, it is still the second leading cause of cancer-related death in the country and the number one cause of cancer death, especially among working-age individuals.

Liver cancer ranks fourth in the socioeconomic burden of cancer, requiring sustained management and prevention efforts at the national level, the association said. This shows that liver cancer has a significant impact on society, and reducing the societal burden of liver cancer through early detection and appropriate treatment remains a major challenge.

Lifestyle diseases, formerly known as adult diseases, are a group of non-infectious conditions that are caused or exacerbated by unhealthy lifestyles, including poor diet, lack of exercise, and excessive alcohol and tobacco use. Examples include “metabolic syndrome” and “metabolic fatty liver disease,” the prevalence of which has been steadily increasing in recent years.

"Lifestyle diseases are not only dangerous as individual conditions, but they are also a major risk factor for the development of liver cancer," the association emphasized.

Studies have shown that patients with metabolic syndrome have an 81 percent increased risk of developing liver cancer, and patients with metabolic fatty liver disease have more than 10 times the incidence of liver cancer compared to normal people.

"Active prevention and management of lifestyle diseases will play an important role in preventing liver cancer," the association said. “In recent years, the prevalence of lifestyle diseases has been increasing even in patients who have already been diagnosed with liver cancer, so it is important to manage lifestyle diseases to improve the prognosis of patients with liver cancer."