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

Impact of metabolic dysfunction-associated fatty liver disease on survival outcomes in patients undergoing radical resection for hepatitis B virus-related hepatocellular carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of metabolic dysfunction-associated fatty liver disease on survival outcomes in patients undergoing radical resection for hepatitis B virus-related hepatocellular carcinoma Ke-Gong Xiong, Tai-Shun Lin, Qing-Biao Lin, Jin-Feng Kong, Kun-Yu Ke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5423774/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 May, 2025 Read the published version in Scientific Reports → Version 1 posted 6 You are reading this latest preprint version Abstract 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. Health sciences/Diseases/Endocrine system and metabolic diseases Health sciences/Medical research/Outcomes research Health sciences/Oncology/Surgical oncology Metabolic dysfunction-associated fatty liver disease Hepatocellular carcinoma Radical resection Prognosis Figures Figure 1 Figure 2 Figure 3 Introduction Hepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and ranks as the third leading cause of cancer-related mortality worldwide 1 , 2 . The infection of Hepatitis B virus (HBV) is a prominent etiological factor for HCC globally, particularly in sub-Saharan Africa and East Asia 3 , 4 . A survey in China showed that HBV-related HCC (HBV-HCC) accounts for 87.5% of all HCC 5 . Given the scarcity of liver donors and other contributing factors, hepatectomy remains the foremost and most efficacious treatment for early HCC at present 6 , 7 . It is worth noting that the recurrence rate of HCC after radical resection can be as high as 70% within 5 years, significantly impacting patients' prognosis 8 , 9 . The prognosis factors for postoperative recurrence of HCC, such as tumor size, number, differentiation, microvascular invasion (MVI), and tumor capsule, have been established as significant factors 10 , 11 . Nonalcoholic fatty liver disease (NAFLD) has exhibited a progressive increase over the past few decades, reaching a prevalence almost equivalent to that of obesity. It has now emerged as the predominant chronic liver disease worldwide, posing a significant health threat to approximately 25% of the global population 12 , 13 . The redefinition of NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD) in 2020 reflects the enhanced understanding of its etiology and pathogenesis 14 . MAFLD terminology has demonstrated superiority in several crucial aspects compared to traditional NAFLD terminology, including its effective identification of high-risk liver patients and assessment of extra-hepatic mortality risks such as cardiovascular disease and chronic kidney disease 15 – 17 . Given the global high prevalence of MAFLD, it is common for HCC patients to exhibit concurrent MAFLD 18 . Furthermore, in the Asia-Pacific region, there is a frequent co-occurrence of HBV-HCC accompanied by MAFLD 19 . However, there is limited knowledge available regarding the association between MAFLD as a comprehensive term for this metabolic disorder and the prognosis of patients with HBV-HCC undergoing hepatectomy. Therefore, this retrospective study aimed to investigate the clinical impact of MAFLD on survival outcomes in patients with HBV-HCC after radical resection. Methods Study design and patient selection The clinical data of patients with HBV-HCC who underwent radical resection at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2015 to December 2020 were retrospectively collected. This study was approved by the Medical Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (No. 2021-035-01). All patients admitted to the hospital have signed a broad consent, which is a specific type of informed consent obtained upon admission. All methods and studies were conducted in accordance with the relevant guidelines and regulations. Our study findings were reported following the Strengthening the Reporting of Observational Studies in Epidemiology Guidelines. The inclusion criteria were patients with HCC confirmed by histological after radical resection and with favorable liver function reserve (Child-Pugh grade A or B). The exclusion criteria were as follows: without HBV infection; hepatocellular-cholangiocarcinoma (HCC - ICC); presence of other malignant tumors; prior invasive treatment [transcatheter hepatic arterial chemoembolization (TACE) or radiofrequency ablation (RFA)]; multiple intrahepatic metastases, invasion of adjacent organs, or distant metastases; incomplete clinical data and perioperative death. Data Collection The clinical data were retrospectively collected from medical record, including baseline data [(age, sex, body mass index (BMI), alcohol consumption, type 2 diabetes mellitus (T2DM), hypertension, serum biochemistry, HbA1c, high-sensitive C-reactive protein, prothrombin time (PT), white blood cell (WBC), hemoglobin (HB), platelet (PLT), alpha-fetoprotein (AFP), HBsAg, HBV DNA, Child-Pugh grading, BCLC staging, etc.], surgical methods, tumor features (size, number, differentiation, capsule, MVI, microsatellite lesions, etc.), and intraoperative blood transfusion (yes/no). Definition The diagnostic criteria in this study for MAFLD require histologically confirmed hepatic steatosis and the presence of at least one of the following: BMI ≥ 23 kg/m 2 , T2DM, or metabolic dysregulation (MD) 14 . Cirrhosis was defined by the histopathological presence of pseudolobules. The definition of excessive alcohol consumption was based on alcohol intake of ≥ 30 g/d for men and ≥ 20 g/d for women 20 . Radical resection, also known as R0 resection, was defined as complete tumor removal with no microscopic residual cancer at the resection margin, confirmed by histopathological examination. HCC recurrence was defined as the presence of new lesions in the liver detected by imaging examinations that met the diagnosis criteria of HCC 21 . Follow-up All patients with HCC were regularly followed up every 3 months for the first 2 years after radical resection, every 6 months from years 2 to 5, and annually thereafter. Nucleoside antiviral drugs, such as entecavir or tenofovir, were administered in accordance with guidelines. The retreatment strategies for HCC recurrence were discussed by multidisciplinary teams. The primary outcome measures included recurrence-free survival (RFS) and overall survival (OS). RFS was defined as the duration from the date of the radical resection to the date of recurrence or last follow-up. OS was defined as the duration from the date of radical resection to the date of death or final follow-up. Statistical analysis SPSS software (version 22.0) and GraphPad Prism 8.0 were used to perform statistical analysis. Continuous variables were presented as medians (interquartile range, IQR) and compared by using either T-test or Mann-Whitney U test. Categorical variables were presented as count (percentages) and compared by using either a χ2 test or Fisher exact test. RFS and OS were calculated with the Kaplan-Meier method, with group comparisons performed using the log-rank test. Cox regression models were applied to analyze risk factors associated with RFS and OS after radical resection in patients with HBV-HCC. Factors that were significant in the univariate analysis ( P < 0.05) were included in multivariate analyses of RFS and OS. The hazard ratios (HR) and 95% confidence intervals (CI) were also calculated for each factor. P value < 0.05 indicated statistical significance. Results Baseline characteristics of patients with HBV-HCC A total of 1049 HCC patients who underwent radical resection between 2015 and 2020 were screened for this study. We excluded 206 patients, including 83 patients without HBV infection, 31 patients with HCC-ICC, 12 patients with other malignancies, 29 patients who underwent preoperative TACE, 7 patients who underwent preoperative RFA, 10 perioperative death, and 34 patients with incomplete data. Ultimately, 843 patients with HBV-HCC were categorized into two groups based on the presence or absence of MAFLD: MAFLD group (172, 20.4%) and non-MAFLD group (671, 79.6%). Flow chart for the selection of the study population is shown in Fig. 1 . The 843 patients with HBV-HCC consisted of 688 (81.6%) males and 155 (18.4%) females. The median age was 57.0 (49.0–64.0) years. The proportions of patients with BMI ≥ 23 kg/m 2 , T2DM, and MD were 51.5% (434/843), 13.9% (117/843), and 34.1% (287/843), respectively. There were 752 (89.2%) patients with HBV DNA levels ≥ 500 IU/ml, 787 (93.4%) patients with Child-Pugh grade A, and 682 (80.9%) patients with cirrhosis. The median tumor diameter was 4.0 (2.7–6.7) cm. The majority of these tumors were solitary, accounting for 87.3% (736/843) (Table 1 ). Compared with the non-MAFLD group, the MAFLD group exhibited a higher BMI (24.4 vs. 22.4 kg/m 2 , P < 0.001) and a greater proportion of patients with combined BMI ≥ 23 kg/m 2 , T2DM or MD in the MAFLD group (80.2% vs. 44.1%, 25.0% vs. 11.0%, and 51.2% vs. 29.7%; all P < 0.001). Additionally, the ALT levels were also significantly higher in the MAFLD group compared to the non-MAFLD group (35.0 vs. 32.0 IU/L, P = 0.034). The two groups did not exhibit any significant differences in terms of other characteristics (all P > 0.05) (Table 1 ). Table 1 Baseline characteristics of patients with HBV-HCC Variables Patients (n = 843) MAFLD (n = 172) non-MAFLD (n = 671) P value Age (years) 57.0 (49.0–64.0) 57.0 (48.0–62.0) 57.0 (49.0–64.0) 0.388 Male 688 (81.6%) 133 (77.3%) 555 (82.7%) 0.104 BMI (kg/m 2 ) 23.0 (21.1–25.0) 24.4 (22.8–25.8) 22.4 (20.8–24.5) < 0.001 ≥ 23 434 (51.5%) 138 (80.2%) 296 (44.1%) < 0.001 T2DM 117 (13.9%) 43 (25.0%) 74 (11.0%) < 0.001 MD 287 (34.0%) 88 (51.2%) 199 (29.7%) < 0.001 Alcohol consumed 88 (10.4%) 24 (14.0%) 64 (9.5%) 0.091 HBV DNA (≥ 500 IU/mL) 752 (89.2%) 159 (92.4%) 593 (88.4%) 0.125 Cirrhosis 682 (80.9%) 147 (85.5%) 535 (79.7%) 0.110 Child-Pugh grade 0.589 A 787 (93.4%) 159 (92.4%) 628 (93.6%) B 56 (6.6%) 13 (7.6%) 43 (6.4%) WBC (×10 9 /L) 5.5 (4.6–6.6) 5.5 (4.6–6.4) 5.5 (4.5–6.6) 0.690 HB (g/L) 143.0 (139.0-152.0) 143.0 (136.0-154.0) 143.0 (139.0-152.0) 0.839 PLT (×10 9 /L) 168.0 (150.0-208.0) 170.5 (149.0-198.8) 167.0 (150.0-209.0) 0.523 PT (s) 13.4 (12.7–13.9) 13.3 (12.7–13.7) 13.4 (12.8–13.9) 0.136 ALB (g/L) 40.0 (38.0–43.0) 40.0 (38.0-43.8) 40.0 (38.0–43.0) 0.633 TBIL (µmol/L) 16.3 (12.0-21.7) 16.6 (11.9–22.8) 16.3 (12.0-21.6) 0.771 ALT (IU/L) 33.0 (23.0–49.0) 35.0 (27.0–51.0) 32.0 (23.0–49.0) 0.034 AFP (µg/L) 47.7 (6.3-697.4) 48.8 (5.8–217.0) 47.7 (6.3-802.2) 0.219 Tumor diameter (cm) 4.0 (2.7–6.7) 4.0 (2.9-6.0) 4.0 (2.5-7.0) 0.753 Number of tumors 0.416 1 736 (87.3%) 147 (85.5%) 589 (87.8%) ≥ 2 107 (12.7%) 25 (14.5%) 82 (12.2%) Tumor differentiation 0.125 Well 12 (1.4%) 4 (2.3%) 8 (1.2%) Moderate 390 (46.3%) 67 (39.0%) 323 (48.1%) Poor 441 (52.3%) 101 (58.7%) 340 (50.7%) Tumor capsule 0.070 Complete 190 (22.5%) 46 (26.7%) 144 (21.5%) Incomplete 534 (63.3%) 96 (55.8%) 438 (65.3%) No tumor capsule 119 (14.1%) 30 (17.4%) 89 (13.3%) Microvascular invasion 460 (54.6%) 91 (52.9%) 369 (55.0%) 0.624 Microsatellite lesions 189 (22.4%) 35 (20.3%) 154 (23.0%) 0.465 BCLC stage 0.945 0 8 (0.9%) 2 (1.2%) 6 (0.9%) A 755 (89.6%) 154 (89.5%) 601 (89.6%) B 80 (9.5%) 16 (9.3%) 64 (9.5%) Surgical method 0.711 Open 437 (51.8%) 87 (50.6%) 350 (52.2%) Laparoscopic 406 (48.2%) 85 (49.4%) 321 (47.8%) RFS and OS after radical resection in patients with HBV-HCC The median RFS of the MAFLD group and non-MAFLD group was 35.0 and 34.0 months, respectively. There were no significant differences in RFS rates at 1-, 3-, and 5-years between the MAFLD group and the non-MAFLD group (82.8%, 46.3%, and 26.8% vs. 80.6%, 47.4%, and 24.1%; P = 0.361) (Fig. 2 A). The median OS of the MAFLD group and the non-MAFLD group was 56.0 and 54.0 months, respectively. There were also no significant differences in OS rates at 1-, 3-, and 5-years between the two groups (95.4%, 76.3%, and 43.0% vs. 93.9%, 71.5%, and 38.5%; P = 0.289) (Fig. 2 B). To further elucidate the impact of different subtypes of MAFLD on survival outcomes in patients with HBV-HCC, they were categorized into two groups based on the presence or absence of T2DM: diabetic MAFLD group (43, 25.0%) and non-diabetic MAFLD group (129, 75.0%). Subgroup analysis showed that the median RFS of the diabetic MAFLD, non-diabetic MAFLD and non-MAFLD group were 29.0, 36.0, and 34.0 months, respectively. The 1-, 3-, and 5-year RFS rates were significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group (70.6%, 36.6%, and 19.1% vs. 86.9%, 49.5%, and 29.0%, P = 0.046). There were no significant differences in RFS rates at 1-, 3-, and 5-years between non-MAFLD group and diabetic MAFLD or non-diabetic MAFLD group (all P > 0.05) (Fig. 3 A). The median OS of the diabetic MAFLD, non-diabetic MAFLD, and non-MAFLD groups were 45.0, 59.0, and 56.0 months, respectively. The 1-, 3-, and 5-years OS rates were also significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group (93.3%, 65.3%, and 34.7% vs. 95.4%, 80.0%, and 45.8%, P = 0.039). There were no significant differences in OS rates at 1-, 3-, and 5-years between non-MAFLD group and diabetic MAFLD group or non-diabetic MAFLD group (all P > 0.05) (Fig. 3 B). Prognostic factors for RFS after radical resection in patients with concurrent MAFLD and HBV-HCC Cox regression analysis revealed that among 172 patients with HBV-HCC in the context of MAFLD, diabetic MAFLD was associated with worse RFS after radical resection (HR, 1.569; 95% CI, 1.035–2.380, P = 0.034), but it did not emerge as an independent risk factor ( P = 0.222). The independent risk factors associated with worse RFS included maximum tumor diameter ≥ 5 cm (HR, 1.654; CI, 1.094–2.498, P = 0.017), tumor number ≥ 2 (HR, 1.822; 95% CI, 1.028–3.229, P = 0.040), microsatellite lesions (HR, 1.687; 95% CI, 1.003–2.837, P = 0.049), and BCLC stage B (HR, 1.862; 95% CI, 1.029–3.368, P = 0.040) (Table 2 ). Table 2 Prognostic factors for RFS after radical resection in patients with concurrent MAFLD and HBV-HCC Variables Univariate Multivariate HR (95% CI) P value HR (95% CI) P value Age ≥ 60 (years) 0.759 (0.514–1.120) 0.165 Male 1.011 (0.646–1.581) 0.963 Alcohol consumed 1.620 (0.917–2.863) 0.097 HBV DNA ≥ 500 IU/ml 1.604 (0.652–3.942) 0.303 AFP ≥ 400 µg/L 10.083 (0.678–1.730) 0.738 Cirrhosis 0.711 (0.423–1.197) 0.200 Maximum tumor diameter ≥ 5 cm 1.918 (1.315–2.798) 0.001 1.654 (1.094–2.498) 0.017 Tumor number ≥ 2 2.015 (1.184-3.40) 0.009 1.822 (1.028–3.229) 0.040 Tumor differentiation (poor vs. well or moderate) 1.195 (0.683–2.450) 0.279 Tumor capsule (no vs. complete or incomplete) 1.115 (0.576–1.752) 0.706 MVI 1.641 (1.121–2.404) 0.011 1.086 (0.687–1.717) 0.723 Microsatellite lesions 1.953 (1.256–3.038) 0.003 1.687 (1.003–2.837) 0.049 BCLC stage B 1.825 (1.053–3.163) 0.032 1.862 (1.029–3.368) 0.040 Child-Pugh B 1.383 (0.755–2.530) 0.293 Open surgery 1.690 (1.149–2.486) 0.008 1.406 (0.929–2.128) 0.107 Intraoperative blood transfusion 1.859 (1.126–3.064) 0.015 1.425 (0.846–2.401) 0.183 Diabetic MAFLD 1.569 (1.035–2.380) 0.034 1.334 (0.840–2.119) 0.222 Prognostic factors for OS after radical resection in patients with concurrent MAFLD and HBV-HCC Cox regression analysis revealed that among 172 patients with HBV-HCC in the context of MAFLD, diabetic MAFLD was associated with worse OS after radical resection (HR, 1.662; 95% CI, 1.094–2.525, P = 0.017). Furthermore, it was identified as an independent risk factor (HR, 1.444; 95% CI, 1.082–2.331, P = 0.032). The other independent risk factors associated with worse OS included maximum tumor diameter ≥ 5 cm (HR, 1.399; CI, 1.015–2.139, P = 0.021), tumor number ≥ 2 (HR, 2.031; 95% CI, 1.161–3.552, P = 0.013), and poor tumor differentiation (HR, 1.622; 95% CI, 1.011–1.964, P = 0.040) (Table 3 ). Table 3 Prognostic factors for OS after radical resection in patients with concurrent MAFLD and HBV-HCC Variables Univariate Multivariate HR (95% CI) P value HR (95% CI) P value Age ≥ 60 (years) 0.944 (0.637–1.398) 0.775 Male 1.208 (0.825–2.011) 0.468 Alcohol consumed 1.230 (0.710–2.131) 0.461 HBV DNA ≥ 500IU/ml 1.877 (0.690–5.108) 0.217 AFP ≥ 400µg/L 1.130 (0.704–1.812) 0.613 Cirrhosis 1.201 (0.670–2.153) 0.538 Maximum tumor diameter ≥ 5 cm 1.643 (1.110–2.431) 0.013 1.399 (1.015–2.139) 0.021 Tumor number ≥ 2 2.405 (1.417–4.081) 0.001 2.031 (1.161–3.552) 0.013 Tumor differentiation (poor vs. well or moderate) 1.443 (1.017–1.918) 0.007 1.622 (1.011–1.964) 0.040 Tumor capsule (no vs. complete or incomplete) 1.224 (1.037–1.971) 0.037 1.285 (0.917–2.126) 0.136 MVI 1.855 (1.316–2.906) 0.001 1.438 (0.903–2.288) 0.126 Microsatellite lesions 2.105 (1.330–3.332) 0.001 1.541 (0.888–2.674) 0.124 BCLC stage B 1.625 (0.889–2.351) 0.232 Child-Pugh B 1.597 (0.907–2.814) 0.105 Open surgery 1.508 (1.019–2.230) 0.040 1.210 (0.779–1.880) 0.397 Intraoperative blood transfusion 1.389 (0.849–2.274) 0.191 Diabetic MAFLD 1.662 (1.094–2.525) 0.017 1.444 (1.082–2.331) 0.032 Discussion In this study, we retrospectively evaluated the clinical impact of MAFLD on the long-term prognosis of patients with HBV-HCC after radical resection. We found that concomitant MAFLD in patients with HBV-HCC after radical resection had no impact on either RFS or OS. Notably, within the MAFLD subgroup, diabetic MAFLD was an independent risk factor for poor prognosis in patients with HBV-HCC after radical resection. HCC patients with concurrent MAFLD are becoming increasingly prevalent due to the rising incidence of MAFLD. The overall prevalence of MAFLD in the population was 38.8% 22 , while among overweight/obese adults, it reached 50.7% 23 . We observed that a substantial proportion of patients with HBV-HCC had MAFLD, accounting for 20.4%. The key disparity in baseline characteristics between the MAFLD group and the non-MAFLD group was the presence of metabolic disorders, with a higher prevalence observed in the MAFLD group. The heterogeneity of MAFLD, which includes various metabolic traits in its diagnostic criteria, accounts for this observed discrepancy. Our study found that the presence of MAFLD does not exert any significant influence on the tumor pathological characteristics of HBV-HCC. This was inconsistent with previous research that patients with concurrent HBV-HCC and MAFLD exhibit superior histological differentiation and lower rates of MVI 19 . Therefore, the confirmation of whether MAFLD influences the tumor pathological features of HBV-HCC requires multi-center and large sample clinical studies, as well as basic research. The occurrence of postoperative recurrence remains a challenge in achieving satisfactory long-term survival, regardless of the etiology of HCC and the treatment strategy. A multicenter retrospective study of 756 patients who underwent radical hepatectomy abroad demonstrated a recurrence rate of 45.5% at a median follow-up of 36 months 24 . In order to evaluate the impact of MAFLD on the long-term prognosis of patients with HBV-HCC after radical resection, we analyzed the 1-, 3-, and 5-years RFS and OS in both the MAFLD and non-MAFLD groups, revealing no discernible differences. These findings suggest that MAFLD does not impact the RFS and OS rate in patients with HBV-HCC following radical resection. These findings are consistent with previous research 19 , 25 , 26 . However, a prior study found that MAFLD was significantly associated with poor prognosis in terms of HCC recurrence and all-cause mortality following surgical resection of HBV-HCC 27 . Nevertheless, this study lacked critical data regarding tumor characteristics (size and number), histopathological parameters (including R0 resection status, MVI, and tumor differentiation grade), serum HBV-DNA levels, and radiological confirmation of HCC recurrence. However, subgroup analysis showed that the 1-, 3-, and 5-years RFS and OS rates were significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group. Moreover, the presence of diabetic MAFLD was further identified as an independent risk factor for OS. Our findings revealed that among the diagnostic criteria for MAFLD, diabetic MAFLD was the only subtype capable of independently identifying a significantly increased mortality rate following radical resection for HBV-HCC. Population-based studies conducted over the past two decades have consistently demonstrated that diabetes was an independent metabolic risk factor for HCC and mortality, both in the general population and in patients with chronic hepatitis B 28 , 29 . The results of two studies involving patients with biopsy-proven MAFLD-related cirrhosis indicated that diabetes was significantly associated with an increased risk of HCC and mortality 30 , 31 . Our findings extend previous findings showing that patients with concurrent HBV-HCC and diabetic MAFLD had worse OS after radical resection than patients with non-diabetic MAFLD, which suggests a stronger association of diabetes than other metabolic characteristics with the long-term outcome of HBV-HCC. It is well known that insulin resistance serves as a shared pathophysiological hallmark of both T2DM and MAFLD. During hepatic fat accumulation, intracellular damage and insulin resistance synergistically exacerbate inflammation, fibrosis, and carcinogenesis 32 . Furthermore, elevated insulin levels can activate the insulin-like growth factor 1 signaling pathway, consequently driving tumor cell proliferation and survival 33 . This study has certain limitations. Firstly, due to the inclusion of only patients with HBV-HCC who underwent R0 resection in the study population, it was not feasible to evaluate the impact of MAFLD on the prognosis of non-R0 resection patients with HBV-HCC. The prognosis of non-R0 resection patients, however, was unfavorable, with the characteristics of the tumor itself being the primary determinant influencing their prognosis 34 . Secondly, this study may lead to an underestimation of the MAFLD population due to incomplete clinical data, such as inadequate measurement of waist circumference and HOMA-IR. However, our study included a substantial sample size, thereby enhancing the reliability of the findings. Thirdly, as a retrospective study, the original medical records suffered from inconsistent documentation of detailed surgical classifications (e.g., anatomical resection, non-anatomical resection, or major hepatectomy), precluding a comprehensive analysis of this parameter. Furthermore, our study could not assess the dynamic effects of time-varying variables, including antiviral therapy adherence, BMI, or cardiometabolic risk factors. Future prospective studies systematically collect standardized surgical data and dynamically monitor time-varying variables will be crucial for clarifying the impact of MAFLD on the prognosis of HBV-HCC. Fourthly, the findings of this study, conducted at a single center, necessitate validation through a multi-center study. In conclusion, concomitant diabetic MAFLD was an independent risk factor for poor prognosis after radical resection in patients with HBV-HCC. Our findings emphasize the necessity of close monitoring and effective treatment for diabetic MAFLD to enhance long-term prognosis for patients with HBV-HCC. Declarations Acknowledgments None. C ontributions K-GX and K-YK were involved in the conception and design of the study. K-GX, T-SL, J-FK and Q-BL collected and analyzed data. K-GX drafted the manuscript. J-FK and K-YK revised the manuscript. J-FK supervised the study. K-GX obtained funding. K-YK was the overall guarantor of the study. All authors have revised and approved the final version for publication. Funding information This study was supported by the Natural Science Foundation of Fujian Province (No. 2023J011462) and Fuzhou Science and Technology Bureau (No. 2023-S-003). Conflict of interest All authors declare that they have no conflict of interest to disclose. Ethical Approval This study was approved by the Medical Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (No. 2021-035-01). Patient consent statement All patients admitted to the hospital have signed a broad consent, which is a specific type of informed consent obtained upon admission. This enables the utilization of health data in future research without necessitating additional consent during ethical review. Data availability statement Data are available from the first author or corresponding author on reasonable request. References Sung, H. et al. 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Gut 72 , 141–152 (2023). Lin, Y-P. et al. Impact of MAFLD on HBV-Related Stage 0/A Hepatocellular Carcinoma after Curative Resection. J. Personalized Med. 11 (8), 684 (2021). Fan, J. G. et al. Guidelines of prevention and treatment of nonalcoholic fatty liver disease (2018, China). J. Dig. Dis. 20 , 163–173 (2019). Xie, D. Y. et al. 2019 Chinese clinical guidelines for the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg. Nutr. 9 , 452–463 (2020). Chan, K. E. K. T. et al. Global Prevalence and Clinical Characteristics of Metabolic-associated Fatty Liver Disease_ A Meta-Analysis and Systematic Review of 10 739 607 Individuals. J. Clin. Endocrinol. Metab. 107 (9), 2691–2700 (2022). Liu, J. et al. Estimating Global Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in Overweight or Obese Adults. Clin. Gastroenterol. Hepatol. 20 , e573–e582 (2022). Tsilimigras, D. I. et al. Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Ann. Surg. Oncol. 27 , 2321–2331 (2020). Yoon, J. S. et al. Prognostic impact of concurrent nonalcoholic fatty liver disease in patients with chronic hepatitis B-related hepatocellular carcinoma. J. Gastroenterol. Hepatol. 35 , 1960–1968 (2020). Xu, H., Liu, Y. & Wei, Y. Impact of metabolic dysfunction-associated fatty liver disease on the outcomes following laparoscopic hepatectomy for hepatocellular carcinoma. Surg. Endosc. 38 , 6456–6463 (2024). Yun, B. et al. Prognostic Impact of MAFLD Following Surgical Resection of Hepatitis B Virus-Related Hepatocellular Carcinoma: A Nationwide Cohort Study. Cancers (Basel) . 14 (20), 5002 (2022). Yang, C. et al. Associations between diabetes mellitus and the risk of hepatocellular carcinoma in Asian individuals with hepatitis B and C infection: systematic review and a meta-analysis of cohort studies. Eur. J. Cancer Prev. 31 , 107–116 (2022). Campbell, C. et al. Risk factors for the development of hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) infection: a systematic review and meta-analysis. J. Viral Hepat. 28 , 493–507 (2021). Yang, J. D. et al. Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease. Hepatology 71 , 907–916 (2019). Vilar-Gomez, E. et al. Type 2 Diabetes and Metformin Use Associate With Outcomes of Patients With Nonalcoholic Steatohepatitis–Related, Child–Pugh A Cirrhosis. Clin. Gastroenterol. Hepatol. 19 , 136–145e6 (2021). Sakurai, Y. et al. Role of Insulin Resistance in MAFLD. Int. J. Mol. Sci. 22 (8), 4156 (2021). Gjorgjieva, M. et al. Hepatic IR and IGF1R signaling govern distinct metabolic and carcinogenic processes upon PTEN deficiency in the liver. JHEP Rep. 7 (4), 101305 (2025). Reig, M. et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J. Hepatol. 76 , 681–693 (2022). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 19 May, 2025 Reviews received at journal 21 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers invited by journal 10 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5423774","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":441158250,"identity":"d056a26c-176d-46ae-849d-e57734f5c9b3","order_by":0,"name":"Ke-Gong Xiong","email":"","orcid":"","institution":"Mengchao Hepatobiliary Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ke-Gong","middleName":"","lastName":"Xiong","suffix":""},{"id":441158251,"identity":"11623302-f74d-4777-b4dd-e9c6cb8232ff","order_by":1,"name":"Tai-Shun Lin","email":"","orcid":"","institution":"Mengchao Hepatobiliary Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tai-Shun","middleName":"","lastName":"Lin","suffix":""},{"id":441158252,"identity":"021f6e6d-b060-4dc0-81c5-70faa27224c2","order_by":2,"name":"Qing-Biao Lin","email":"","orcid":"","institution":"Mengchao Hepatobiliary Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qing-Biao","middleName":"","lastName":"Lin","suffix":""},{"id":441158253,"identity":"bcdc3fbd-5159-45b1-ba05-efa41cf9b978","order_by":3,"name":"Jin-Feng Kong","email":"","orcid":"","institution":"Mengchao Hepatobiliary Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jin-Feng","middleName":"","lastName":"Kong","suffix":""},{"id":441158254,"identity":"64162f0a-e7a5-47d5-90c4-83907dd72742","order_by":4,"name":"Kun-Yu Ke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACCQY2MM3Dxt74wADMPECkFhk+nsMGpGmxkZNIhuggqEWyvS1NurDtMA+b5GOGopttDHJ8NxIYPxfg0SLNc+yY9EyQFulkBuPcNgZjyRsJzNIz8GiRk0hvk+YFa8k/ANKSuOFGAhszDz4t8s+hWiQPg22pJ6hFWoLtGESLBDNYS4IBIS2SPWnJ1jzn0nnYeIB+yTknYTjzzMNmaXxaJI4fM7zNU2ZtL99+mM04p8xGnu948sHP+LSAASMkbtgMQPEE5DYQ0gAEf8Ak8wMilI6CUTAKRsEIBAAFSEBUrfwl+gAAAABJRU5ErkJggg==","orcid":"","institution":"Mengchao Hepatobiliary Hospital of Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Kun-Yu","middleName":"","lastName":"Ke","suffix":""}],"badges":[],"createdAt":"2024-11-10 00:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5423774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5423774/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-03244-9","type":"published","date":"2025-05-23T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80577190,"identity":"1a5b81ff-1432-4ca5-a9d5-a1f6dd40dc2f","added_by":"auto","created_at":"2025-04-14 22:55:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":797364,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart for the selection of the study population. HCC, hepatocellular carcinoma; HBV, hepatitis B virus; HBV-HCC, hepatitis B virus-related hepatocellular carcinoma; MAFLD, metabolic dysfunction-associated fatty liver disease; HCC-ICC, combined hepatocellular- cholangiocarcinoma; TACE, transcatheter hepatic arterial chemoembolization; RFA, radiofrequency ablation.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5423774/v1/268702b5c592b98f3a6ab5dc.png"},{"id":80577191,"identity":"7b7a6f64-d9ea-46f8-8ddd-46ab6be2c070","added_by":"auto","created_at":"2025-04-14 22:55:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1104333,"visible":true,"origin":"","legend":"\u003cp\u003eRFS (A) and OS (B) in two groups of patients with HBV-HCC. MAFLD, metabolic dysfunction-associated fatty liver disease; HBV-HCC, hepatitis B virus-related hepatocellular carcinoma; RFS, recurrence-free survival; OS, overall survival.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5423774/v1/1fdedf23764e317c7cfb4619.png"},{"id":80578564,"identity":"afcd1a5b-5da2-464d-bd84-446851a1df1f","added_by":"auto","created_at":"2025-04-14 23:03:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1766376,"visible":true,"origin":"","legend":"\u003cp\u003eRFS (A) and OS (B) in three groups of patients with HBV-HCC. MAFLD, metabolic dysfunction-associated fatty liver disease; HBV-HCC, hepatitis B virus-related hepatocellular carcinoma. RFS, recurrence-free survival; OS, overall survival.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5423774/v1/b747e78599e465d2bc3610d8.png"},{"id":83460001,"identity":"aca7a6a5-0d2b-49ea-86cc-4b18bea3a4ef","added_by":"auto","created_at":"2025-05-26 16:08:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5977102,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5423774/v1/dd04eced-5d99-4659-a7c4-bf7f2aaa6f26.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of metabolic dysfunction-associated fatty liver disease on survival outcomes in patients undergoing radical resection for hepatitis B virus-related hepatocellular carcinoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and ranks as the third leading cause of cancer-related mortality worldwide\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The infection of Hepatitis B virus (HBV) is a prominent etiological factor for HCC globally, particularly in sub-Saharan Africa and East Asia\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. A survey in China showed that HBV-related HCC (HBV-HCC) accounts for 87.5% of all HCC\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Given the scarcity of liver donors and other contributing factors, hepatectomy remains the foremost and most efficacious treatment for early HCC at present\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. It is worth noting that the recurrence rate of HCC after radical resection can be as high as 70% within 5 years, significantly impacting patients' prognosis\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The prognosis factors for postoperative recurrence of HCC, such as tumor size, number, differentiation, microvascular invasion (MVI), and tumor capsule, have been established as significant factors\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNonalcoholic fatty liver disease (NAFLD) has exhibited a progressive increase over the past few decades, reaching a prevalence almost equivalent to that of obesity. It has now emerged as the predominant chronic liver disease worldwide, posing a significant health threat to approximately 25% of the global population\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The redefinition of NAFLD as metabolic dysfunction-associated fatty liver disease (MAFLD) in 2020 reflects the enhanced understanding of its etiology and pathogenesis \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. MAFLD terminology has demonstrated superiority in several crucial aspects compared to traditional NAFLD terminology, including its effective identification of high-risk liver patients and assessment of extra-hepatic mortality risks such as cardiovascular disease and chronic kidney disease\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven the global high prevalence of MAFLD, it is common for HCC patients to exhibit concurrent MAFLD\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Furthermore, in the Asia-Pacific region, there is a frequent co-occurrence of HBV-HCC accompanied by MAFLD\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. However, there is limited knowledge available regarding the association between MAFLD as a comprehensive term for this metabolic disorder and the prognosis of patients with HBV-HCC undergoing hepatectomy. Therefore, this retrospective study aimed to investigate the clinical impact of MAFLD on survival outcomes in patients with HBV-HCC after radical resection.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patient selection\u003c/h2\u003e \u003cp\u003eThe clinical data of patients with HBV-HCC who underwent radical resection at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2015 to December 2020 were retrospectively collected. This study was approved by the Medical Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (No. 2021-035-01). All patients admitted to the hospital have signed a broad consent, which is a specific type of informed consent obtained upon admission. All methods and studies were conducted in accordance with the relevant guidelines and regulations. Our study findings were reported following the Strengthening the Reporting of Observational Studies in Epidemiology Guidelines. The inclusion criteria were patients with HCC confirmed by histological after radical resection and with favorable liver function reserve (Child-Pugh grade A or B). The exclusion criteria were as follows: without HBV infection; hepatocellular-cholangiocarcinoma (HCC - ICC); presence of other malignant tumors; prior invasive treatment [transcatheter hepatic arterial chemoembolization (TACE) or radiofrequency ablation (RFA)]; multiple intrahepatic metastases, invasion of adjacent organs, or distant metastases; incomplete clinical data and perioperative death.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe clinical data were retrospectively collected from medical record, including baseline data [(age, sex, body mass index (BMI), alcohol consumption, type 2 diabetes mellitus (T2DM), hypertension, serum biochemistry, HbA1c, high-sensitive C-reactive protein, prothrombin time (PT), white blood cell (WBC), hemoglobin (HB), platelet (PLT), alpha-fetoprotein (AFP), HBsAg, HBV DNA, Child-Pugh grading, BCLC staging, etc.], surgical methods, tumor features (size, number, differentiation, capsule, MVI, microsatellite lesions, etc.), and intraoperative blood transfusion (yes/no).\u003c/p\u003e\n\u003ch3\u003eDefinition\u003c/h3\u003e\n\u003cp\u003eThe diagnostic criteria in this study for MAFLD require histologically confirmed hepatic steatosis and the presence of at least one of the following: BMI\u0026thinsp;\u0026ge;\u0026thinsp;23 kg/m\u003csup\u003e2\u003c/sup\u003e, T2DM, or metabolic dysregulation (MD)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Cirrhosis was defined by the histopathological presence of pseudolobules. The definition of excessive alcohol consumption was based on alcohol intake of \u0026ge;\u0026thinsp;30 g/d for men and \u0026ge;\u0026thinsp;20 g/d for women\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Radical resection, also known as R0 resection, was defined as complete tumor removal with no microscopic residual cancer at the resection margin, confirmed by histopathological examination. HCC recurrence was defined as the presence of new lesions in the liver detected by imaging examinations that met the diagnosis criteria of HCC\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eAll patients with HCC were regularly followed up every 3 months for the first 2 years after radical resection, every 6 months from years 2 to 5, and annually thereafter. Nucleoside antiviral drugs, such as entecavir or tenofovir, were administered in accordance with guidelines. The retreatment strategies for HCC recurrence were discussed by multidisciplinary teams. The primary outcome measures included recurrence-free survival (RFS) and overall survival (OS). RFS was defined as the duration from the date of the radical resection to the date of recurrence or last follow-up. OS was defined as the duration from the date of radical resection to the date of death or final follow-up.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS software (version 22.0) and GraphPad Prism 8.0 were used to perform statistical analysis. Continuous variables were presented as medians (interquartile range, IQR) and compared by using either T-test or Mann-Whitney U test. Categorical variables were presented as count (percentages) and compared by using either a χ2 test or Fisher exact test. RFS and OS were calculated with the Kaplan-Meier method, with group comparisons performed using the log-rank test. Cox regression models were applied to analyze risk factors associated with RFS and OS after radical resection in patients with HBV-HCC. Factors that were significant in the univariate analysis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were included in multivariate analyses of RFS and OS. The hazard ratios (HR) and 95% confidence intervals (CI) were also calculated for each factor. \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics of patients with HBV-HCC\u003c/h2\u003e \u003cp\u003eA total of 1049 HCC patients who underwent radical resection between 2015 and 2020 were screened for this study. We excluded 206 patients, including 83 patients without HBV infection, 31 patients with HCC-ICC, 12 patients with other malignancies, 29 patients who underwent preoperative TACE, 7 patients who underwent preoperative RFA, 10 perioperative death, and 34 patients with incomplete data. Ultimately, 843 patients with HBV-HCC were categorized into two groups based on the presence or absence of MAFLD: MAFLD group (172, 20.4%) and non-MAFLD group (671, 79.6%). Flow chart for the selection of the study population is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe 843 patients with HBV-HCC consisted of 688 (81.6%) males and 155 (18.4%) females. The median age was 57.0 (49.0\u0026ndash;64.0) years. The proportions of patients with BMI\u0026thinsp;\u0026ge;\u0026thinsp;23 kg/m\u003csup\u003e2\u003c/sup\u003e, T2DM, and MD were 51.5% (434/843), 13.9% (117/843), and 34.1% (287/843), respectively. There were 752 (89.2%) patients with HBV DNA levels\u0026thinsp;\u0026ge;\u0026thinsp;500 IU/ml, 787 (93.4%) patients with Child-Pugh grade A, and 682 (80.9%) patients with cirrhosis. The median tumor diameter was 4.0 (2.7\u0026ndash;6.7) cm. The majority of these tumors were solitary, accounting for 87.3% (736/843) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Compared with the non-MAFLD group, the MAFLD group exhibited a higher BMI (24.4 vs. 22.4 kg/m\u003csup\u003e2\u003c/sup\u003e, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a greater proportion of patients with combined BMI\u0026thinsp;\u0026ge;\u0026thinsp;23 kg/m\u003csup\u003e2\u003c/sup\u003e, T2DM or MD in the MAFLD group (80.2% vs. 44.1%, 25.0% vs. 11.0%, and 51.2% vs. 29.7%; all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the ALT levels were also significantly higher in the MAFLD group compared to the non-MAFLD group (35.0 vs. 32.0 IU/L, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034). The two groups did not exhibit any significant differences in terms of other characteristics (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients with HBV-HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;843)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAFLD (n\u0026thinsp;=\u0026thinsp;172)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003enon-MAFLD (n\u0026thinsp;=\u0026thinsp;671)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.0 (49.0\u0026ndash;64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.0 (48.0\u0026ndash;62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.0 (49.0\u0026ndash;64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e688 (81.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e555 (82.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.0 (21.1\u0026ndash;25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.4 (22.8\u0026ndash;25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.4 (20.8\u0026ndash;24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e434 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138 (80.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e296 (44.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e287 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e199 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV DNA (\u0026ge;\u0026thinsp;500 IU/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e752 (89.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e593 (88.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e682 (80.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147 (85.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e535 (79.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Pugh grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e787 (93.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (92.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e628 (93.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.5 (4.6\u0026ndash;6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.5 (4.6\u0026ndash;6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.5 (4.5\u0026ndash;6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143.0 (139.0-152.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143.0 (136.0-154.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143.0 (139.0-152.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e168.0 (150.0-208.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170.5 (149.0-198.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e167.0 (150.0-209.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT (s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.4 (12.7\u0026ndash;13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.3 (12.7\u0026ndash;13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.4 (12.8\u0026ndash;13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40.0 (38.0\u0026ndash;43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.0 (38.0-43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.0 (38.0\u0026ndash;43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBIL (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.3 (12.0-21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.6 (11.9\u0026ndash;22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.3 (12.0-21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.0 (23.0\u0026ndash;49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.0 (27.0\u0026ndash;51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.0 (23.0\u0026ndash;49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFP (\u0026micro;g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47.7 (6.3-697.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.8 (5.8\u0026ndash;217.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.7 (6.3-802.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor diameter (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.0 (2.7\u0026ndash;6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0 (2.9-6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.0 (2.5-7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e736 (87.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147 (85.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e589 (87.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e390 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (39.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e323 (48.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e441 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e340 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor capsule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e190 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e534 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e438 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo tumor capsule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrovascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e460 (54.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e369 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrosatellite lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e154 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCLC stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e755 (89.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154 (89.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e601 (89.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e437 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e350 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e406 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e321 (47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRFS and OS after radical resection in patients with HBV-HCC\u003c/h3\u003e\n\u003cp\u003eThe median RFS of the MAFLD group and non-MAFLD group was 35.0 and 34.0 months, respectively. There were no significant differences in RFS rates at 1-, 3-, and 5-years between the MAFLD group and the non-MAFLD group (82.8%, 46.3%, and 26.8% vs. 80.6%, 47.4%, and 24.1%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.361) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). The median OS of the MAFLD group and the non-MAFLD group was 56.0 and 54.0 months, respectively. There were also no significant differences in OS rates at 1-, 3-, and 5-years between the two groups (95.4%, 76.3%, and 43.0% vs. 93.9%, 71.5%, and 38.5%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.289) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo further elucidate the impact of different subtypes of MAFLD on survival outcomes in patients with HBV-HCC, they were categorized into two groups based on the presence or absence of T2DM: diabetic MAFLD group (43, 25.0%) and non-diabetic MAFLD group (129, 75.0%).\u003c/p\u003e \u003cp\u003eSubgroup analysis showed that the median RFS of the diabetic MAFLD, non-diabetic MAFLD and non-MAFLD group were 29.0, 36.0, and 34.0 months, respectively. The 1-, 3-, and 5-year RFS rates were significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group (70.6%, 36.6%, and 19.1% vs. 86.9%, 49.5%, and 29.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046). There were no significant differences in RFS rates at 1-, 3-, and 5-years between non-MAFLD group and diabetic MAFLD or non-diabetic MAFLD group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). The median OS of the diabetic MAFLD, non-diabetic MAFLD, and non-MAFLD groups were 45.0, 59.0, and 56.0 months, respectively. The 1-, 3-, and 5-years OS rates were also significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group (93.3%, 65.3%, and 34.7% vs. 95.4%, 80.0%, and 45.8%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039). There were no significant differences in OS rates at 1-, 3-, and 5-years between non-MAFLD group and diabetic MAFLD group or non-diabetic MAFLD group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrognostic factors for RFS after radical resection in patients with concurrent MAFLD and HBV-HCC\u003c/h2\u003e \u003cp\u003eCox regression analysis revealed that among 172 patients with HBV-HCC in the context of MAFLD, diabetic MAFLD was associated with worse RFS after radical resection (HR, 1.569; 95% CI, 1.035\u0026ndash;2.380, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034), but it did not emerge as an independent risk factor (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.222). The independent risk factors associated with worse RFS included maximum tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm (HR, 1.654; CI, 1.094\u0026ndash;2.498, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017), tumor number\u0026thinsp;\u0026ge;\u0026thinsp;2 (HR, 1.822; 95% CI, 1.028\u0026ndash;3.229, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), microsatellite lesions (HR, 1.687; 95% CI, 1.003\u0026ndash;2.837, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049), and BCLC stage B (HR, 1.862; 95% CI, 1.029\u0026ndash;3.368, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrognostic factors for RFS after radical resection in patients with concurrent MAFLD and HBV-HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;60 (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.759 (0.514\u0026ndash;1.120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.011 (0.646\u0026ndash;1.581)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.620 (0.917\u0026ndash;2.863)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV DNA\u0026thinsp;\u0026ge;\u0026thinsp;500 IU/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.604 (0.652\u0026ndash;3.942)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFP\u0026thinsp;\u0026ge;\u0026thinsp;400 \u0026micro;g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.083 (0.678\u0026ndash;1.730)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.711 (0.423\u0026ndash;1.197)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.918 (1.315\u0026ndash;2.798)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.654 (1.094\u0026ndash;2.498)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor number\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.015 (1.184-3.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.822 (1.028\u0026ndash;3.229)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor differentiation (poor vs. well or moderate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.195 (0.683\u0026ndash;2.450)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor capsule (no vs. complete or incomplete)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.115 (0.576\u0026ndash;1.752)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.641 (1.121\u0026ndash;2.404)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.086 (0.687\u0026ndash;1.717)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrosatellite lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.953 (1.256\u0026ndash;3.038)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.687 (1.003\u0026ndash;2.837)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCLC stage B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.825 (1.053\u0026ndash;3.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.862 (1.029\u0026ndash;3.368)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Pugh B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.383 (0.755\u0026ndash;2.530)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.690 (1.149\u0026ndash;2.486)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.406 (0.929\u0026ndash;2.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.859 (1.126\u0026ndash;3.064)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.425 (0.846\u0026ndash;2.401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic MAFLD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.569 (1.035\u0026ndash;2.380)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.334 (0.840\u0026ndash;2.119)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrognostic factors for OS after radical resection in patients with concurrent MAFLD and HBV-HCC\u003c/h2\u003e \u003cp\u003eCox regression analysis revealed that among 172 patients with HBV-HCC in the context of MAFLD, diabetic MAFLD was associated with worse OS after radical resection (HR, 1.662; 95% CI, 1.094\u0026ndash;2.525, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017). Furthermore, it was identified as an independent risk factor (HR, 1.444; 95% CI, 1.082\u0026ndash;2.331, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032). The other independent risk factors associated with worse OS included maximum tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm (HR, 1.399; CI, 1.015\u0026ndash;2.139, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021), tumor number\u0026thinsp;\u0026ge;\u0026thinsp;2 (HR, 2.031; 95% CI, 1.161\u0026ndash;3.552, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), and poor tumor differentiation (HR, 1.622; 95% CI, 1.011\u0026ndash;1.964, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrognostic factors for OS after radical resection in patients with concurrent MAFLD and HBV-HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;60 (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.944 (0.637\u0026ndash;1.398)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.208 (0.825\u0026ndash;2.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.230 (0.710\u0026ndash;2.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV DNA\u0026thinsp;\u0026ge;\u0026thinsp;500IU/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.877 (0.690\u0026ndash;5.108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFP\u0026thinsp;\u0026ge;\u0026thinsp;400\u0026micro;g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.130 (0.704\u0026ndash;1.812)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.201 (0.670\u0026ndash;2.153)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor diameter\u0026thinsp;\u0026ge;\u0026thinsp;5 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.643 (1.110\u0026ndash;2.431)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.399 (1.015\u0026ndash;2.139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor number\u0026thinsp;\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.405 (1.417\u0026ndash;4.081)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.031 (1.161\u0026ndash;3.552)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor differentiation (poor vs. well or moderate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.443 (1.017\u0026ndash;1.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.622 (1.011\u0026ndash;1.964)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor capsule (no vs. complete or incomplete)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.224 (1.037\u0026ndash;1.971)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.285 (0.917\u0026ndash;2.126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.855 (1.316\u0026ndash;2.906)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.438 (0.903\u0026ndash;2.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMicrosatellite lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.105 (1.330\u0026ndash;3.332)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.541 (0.888\u0026ndash;2.674)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCLC stage B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.625 (0.889\u0026ndash;2.351)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Pugh B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.597 (0.907\u0026ndash;2.814)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.508 (1.019\u0026ndash;2.230)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.210 (0.779\u0026ndash;1.880)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.389 (0.849\u0026ndash;2.274)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic MAFLD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.662 (1.094\u0026ndash;2.525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.444 (1.082\u0026ndash;2.331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we retrospectively evaluated the clinical impact of MAFLD on the long-term prognosis of patients with HBV-HCC after radical resection. We found that concomitant MAFLD in patients with HBV-HCC after radical resection had no impact on either RFS or OS. Notably, within the MAFLD subgroup, diabetic MAFLD was an independent risk factor for poor prognosis in patients with HBV-HCC after radical resection.\u003c/p\u003e \u003cp\u003eHCC patients with concurrent MAFLD are becoming increasingly prevalent due to the rising incidence of MAFLD. The overall prevalence of MAFLD in the population was 38.8%\u003csup\u003e22\u003c/sup\u003e, while among overweight/obese adults, it reached 50.7%\u003csup\u003e23\u003c/sup\u003e. We observed that a substantial proportion of patients with HBV-HCC had MAFLD, accounting for 20.4%. The key disparity in baseline characteristics between the MAFLD group and the non-MAFLD group was the presence of metabolic disorders, with a higher prevalence observed in the MAFLD group. The heterogeneity of MAFLD, which includes various metabolic traits in its diagnostic criteria, accounts for this observed discrepancy. Our study found that the presence of MAFLD does not exert any significant influence on the tumor pathological characteristics of HBV-HCC. This was inconsistent with previous research that patients with concurrent HBV-HCC and MAFLD exhibit superior histological differentiation and lower rates of MVI\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Therefore, the confirmation of whether MAFLD influences the tumor pathological features of HBV-HCC requires multi-center and large sample clinical studies, as well as basic research.\u003c/p\u003e \u003cp\u003eThe occurrence of postoperative recurrence remains a challenge in achieving satisfactory long-term survival, regardless of the etiology of HCC and the treatment strategy. A multicenter retrospective study of 756 patients who underwent radical hepatectomy abroad demonstrated a recurrence rate of 45.5% at a median follow-up of 36 months\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In order to evaluate the impact of MAFLD on the long-term prognosis of patients with HBV-HCC after radical resection, we analyzed the 1-, 3-, and 5-years RFS and OS in both the MAFLD and non-MAFLD groups, revealing no discernible differences. These findings suggest that MAFLD does not impact the RFS and OS rate in patients with HBV-HCC following radical resection. These findings are consistent with previous research\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, a prior study found that MAFLD was significantly associated with poor prognosis in terms of HCC recurrence and all-cause mortality following surgical resection of HBV-HCC\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Nevertheless, this study lacked critical data regarding tumor characteristics (size and number), histopathological parameters (including R0 resection status, MVI, and tumor differentiation grade), serum HBV-DNA levels, and radiological confirmation of HCC recurrence.\u003c/p\u003e \u003cp\u003eHowever, subgroup analysis showed that the 1-, 3-, and 5-years RFS and OS rates were significantly lower in the diabetic MAFLD group compared to the non-diabetic MAFLD group. Moreover, the presence of diabetic MAFLD was further identified as an independent risk factor for OS. Our findings revealed that among the diagnostic criteria for MAFLD, diabetic MAFLD was the only subtype capable of independently identifying a significantly increased mortality rate following radical resection for HBV-HCC. Population-based studies conducted over the past two decades have consistently demonstrated that diabetes was an independent metabolic risk factor for HCC and mortality, both in the general population and in patients with chronic hepatitis B\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The results of two studies involving patients with biopsy-proven MAFLD-related cirrhosis indicated that diabetes was significantly associated with an increased risk of HCC and mortality\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Our findings extend previous findings showing that patients with concurrent HBV-HCC and diabetic MAFLD had worse OS after radical resection than patients with non-diabetic MAFLD, which suggests a stronger association of diabetes than other metabolic characteristics with the long-term outcome of HBV-HCC. It is well known that insulin resistance serves as a shared pathophysiological hallmark of both T2DM and MAFLD. During hepatic fat accumulation, intracellular damage and insulin resistance synergistically exacerbate inflammation, fibrosis, and carcinogenesis\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Furthermore, elevated insulin levels can activate the insulin-like growth factor 1 signaling pathway, consequently driving tumor cell proliferation and survival\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. Firstly, due to the inclusion of only patients with HBV-HCC who underwent R0 resection in the study population, it was not feasible to evaluate the impact of MAFLD on the prognosis of non-R0 resection patients with HBV-HCC. The prognosis of non-R0 resection patients, however, was unfavorable, with the characteristics of the tumor itself being the primary determinant influencing their prognosis\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Secondly, this study may lead to an underestimation of the MAFLD population due to incomplete clinical data, such as inadequate measurement of waist circumference and HOMA-IR. However, our study included a substantial sample size, thereby enhancing the reliability of the findings. Thirdly, as a retrospective study, the original medical records suffered from inconsistent documentation of detailed surgical classifications (e.g., anatomical resection, non-anatomical resection, or major hepatectomy), precluding a comprehensive analysis of this parameter. Furthermore, our study could not assess the dynamic effects of time-varying variables, including antiviral therapy adherence, BMI, or cardiometabolic risk factors. Future prospective studies systematically collect standardized surgical data and dynamically monitor time-varying variables will be crucial for clarifying the impact of MAFLD on the prognosis of HBV-HCC. Fourthly, the findings of this study, conducted at a single center, necessitate validation through a multi-center study.\u003c/p\u003e \u003cp\u003eIn conclusion, concomitant diabetic MAFLD was an independent risk factor for poor prognosis after radical resection in patients with HBV-HCC. Our findings emphasize the necessity of close monitoring and effective treatment for diabetic MAFLD to enhance long-term prognosis for patients with HBV-HCC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eontributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK-GX and K-YK were involved in the conception and design of the study. K-GX, T-SL, J-FK and Q-BL collected and analyzed data. K-GX drafted the manuscript. J-FK and K-YK revised the manuscript. J-FK supervised the study. K-GX obtained funding. K-YK was the overall guarantor of the study. All authors have revised and approved the final version for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Natural Science Foundation of Fujian Province (No. 2023J011462) and Fuzhou Science and Technology Bureau (No. 2023-S-003).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflict of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (No. 2021-035-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients admitted to the hospital have signed a broad consent, which is a specific type of informed consent obtained upon admission. This enables the utilization of health data in future research without necessitating additional consent during ethical review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the first author or corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung, H. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. \u003cem\u003eCA Cancer J. Clin.\u003c/em\u003e \u003cb\u003e71\u003c/b\u003e, 209\u0026ndash;249 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia, C. et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. \u003cem\u003eChin. Med. 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Hepatol.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 619\u0026ndash;629e7 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVitale, A. et al. Epidemiological trends and trajectories of MAFLD-associated hepatocellular carcinoma 2002\u0026ndash;2033: the ITA.LI.CA database. \u003cem\u003eGut\u003c/em\u003e \u003cb\u003e72\u003c/b\u003e, 141\u0026ndash;152 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, Y-P. et al. Impact of MAFLD on HBV-Related Stage 0/A Hepatocellular Carcinoma after Curative Resection. \u003cem\u003eJ. Personalized Med.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (8), 684 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan, J. G. et al. Guidelines of prevention and treatment of nonalcoholic fatty liver disease (2018, China). \u003cem\u003eJ. Dig. Dis.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e, 163\u0026ndash;173 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie, D. Y. et al. 2019 Chinese clinical guidelines for the management of hepatocellular carcinoma: updates and insights. \u003cem\u003eHepatobiliary Surg. Nutr.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, 452\u0026ndash;463 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan, K. E. K. T. et al. Global Prevalence and Clinical Characteristics of Metabolic-associated Fatty Liver Disease_ A Meta-Analysis and Systematic Review of 10 739 607 Individuals. \u003cem\u003eJ. Clin. Endocrinol. Metab.\u003c/em\u003e \u003cb\u003e107\u003c/b\u003e (9), 2691\u0026ndash;2700 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu, J. et al. Estimating Global Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in Overweight or Obese Adults. \u003cem\u003eClin. Gastroenterol. Hepatol.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e, e573\u0026ndash;e582 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsilimigras, D. I. et al. 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Prognostic Impact of MAFLD Following Surgical Resection of Hepatitis B Virus-Related Hepatocellular Carcinoma: A Nationwide Cohort Study. \u003cem\u003eCancers (Basel)\u003c/em\u003e. \u003cb\u003e14\u003c/b\u003e (20), 5002 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, C. et al. Associations between diabetes mellitus and the risk of hepatocellular carcinoma in Asian individuals with hepatitis B and C infection: systematic review and a meta-analysis of cohort studies. \u003cem\u003eEur. J. Cancer Prev.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e, 107\u0026ndash;116 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampbell, C. et al. Risk factors for the development of hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) infection: a systematic review and meta-analysis. \u003cem\u003eJ. 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Hepatol.\u003c/em\u003e \u003cb\u003e76\u003c/b\u003e, 681\u0026ndash;693 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Metabolic dysfunction-associated fatty liver disease, Hepatocellular carcinoma, Radical resection, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-5423774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5423774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground \u0026amp; Aims:\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 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 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;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 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, diabetic MAFLD was an independent risk factor associated with poorer OS after radical resection (HR, 1.444; 95% CI, 1.082\u0026ndash;2.331, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eConcomitant diabetic MAFLD is associated with a poor prognosis after radical resection in patients with HBV-HCC.\u003c/p\u003e","manuscriptTitle":"Impact of metabolic dysfunction-associated fatty liver disease on survival outcomes in patients undergoing radical resection for hepatitis B virus-related hepatocellular carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-14 22:55:36","doi":"10.21203/rs.3.rs-5423774/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-19T14:06:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-21T16:38:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294072421561636808359864660018643235515","date":"2025-04-15T12:02:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-10T11:59:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T14:34:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-01T14:18:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7a50cb54-cad7-48fd-9e88-b83b19ce4380","owner":[],"postedDate":"April 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46972724,"name":"Health sciences/Diseases/Endocrine system and metabolic diseases"},{"id":46972725,"name":"Health sciences/Medical research/Outcomes research"},{"id":46972726,"name":"Health sciences/Oncology/Surgical oncology"}],"tags":[],"updatedAt":"2025-05-26T16:01:00+00:00","versionOfRecord":{"articleIdentity":"rs-5423774","link":"https://doi.org/10.1038/s41598-025-03244-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-23 15:57:32","publishedOnDateReadable":"May 23rd, 2025"},"versionCreatedAt":"2025-04-14 22:55:36","video":"","vorDoi":"10.1038/s41598-025-03244-9","vorDoiUrl":"https://doi.org/10.1038/s41598-025-03244-9","workflowStages":[]},"version":"v1","identity":"rs-5423774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5423774","identity":"rs-5423774","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}