The Risk of HCC in Patients with Chronic Hepatitis B is Increased by Concomitant Presence of MAFLD but not NAFLD

Abstract Background: Chronic Hepatitis B virus infection (CHB) and non-alcoholic fatty liver disease (NAFLD) are both independent risk factors for hepatocellular carcinoma (HCC). Current literature suggests the concomitance of CHB and NAFLD do not increase the risk of HCC. The risk of HCC in patients with concomitant CHB and metabolic associated fatty liver disease (MAFLD) is unclear. Methods: CHB patients who underwent liver biopsy from 2005 to 2015 were retrospectively recruited and followed up till March 2020. Cox hazard ratio analysis was used to investigate the risk of HCC.Results: A total of 529 patients were included. MAFLD was diagnosed in 184 (34.78%) and NAFLD in 250 (47.26%) patients. The median follow-up duration was 6.33 years. In the entire cohort, 9 (1.7%) patients developed HCC. The prevalence of MAFLD was significantly higher in HCC group than non-HCC group (77.8% vs. 34.04%, p=0.010), while of the prevalence of NAFLD was not statistically significant (46.73% vs. 77.78%, p=0.092). The presence of MAFLD (HR=6.434; 95%CI: 1.252-33.060) was an independent risk factor for HCC in CHB patients while NAFLD was not. Significantly higher rate of HCC was found in patients with metabolic conditions than those without (2.83% vs. 0.41%, P=0.043), but not in the comparison between steatosis and non-steatosis (2.77% vs. 0.72%, P=0.094). Conclusion: Presence of MAFLD is independently associated with the risk of HCC development in patients with CHB. Between MAFLD and NAFLD, MAFLD will serve these patients better for risk stratification as far as development of HCC is concerned.