Should we undertake surveillance for HCC in patients with MAFLD?

Over the last decade, metabolic-associated fatty liver disease (MAFLD) has become an important public health issue worldwide. In many countries, MAFLD has become the most common cause of chronic liver disease. On the contrary, hepatocellular carcinoma (HCC) mortality is rising. Liver tumors have become the third cause of cancer mortality worldwide. HCC is the most frequent liver tumor. While the burden of HCC related to viral hepatitis is declining, the prevalence of MAFLD-related HCC is rising rapidly. Classical screening criteria for HCC consider cirrhotic, advanced fibrosis, and viral hepatitis patients. Metabolic syndrome with liver involvement or MAFLD is associated with a higher risk of HCC development, even in the absence of cirrhosis. The question about the cost effectiveness of surveillance for HCC in MAFLD is yet not fully answered. There are no guidelines that address the question of when to start or how to define the population who can benefit of surveillance for HCC in MAFLD patients. This review aims to revise the evidence of HCC development in MAFLD. It hopes to be a step closer to defining screening criteria for HCC in MAFLD.

Automated summary

Over the last decade, metabolic-associated fatty liver disease (MAFLD) has emerged as a significant global public health concern, becoming the most common cause of chronic liver disease in many countries. Meanwhile, hepatocellular carcinoma (HCC) mortality rates are increasing, with liver tumors now being the third leading cause of cancer-related death worldwide. With the decline in HCC burden related to viral hepatitis, the prevalence of MAFLD-related HCC is rapidly rising. However, there are still uncertainties regarding the cost-effectiveness and guidelines for HCC surveillance in MAFLD patients. This review aims to address these issues and provide evidence for defining screening criteria for HCC in MAFLD.