ABSTRACT
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new nomenclature recently proposed by a panel of international experts so that the entity is defined based on positive criteria and linked to pathogenesis, replacing the traditional non-alcoholic fatty liver disease (NAFLD), a definition based on exclusion criteria. NAFLD/MAFLD is currently the most common form of chronic liver disease worldwide and is a growing risk factor for development of hepatocellular carcinoma (HCC). It is estimated than 25% of the global population have NAFLD and is projected to increase in the next years. Major Scientific Societies agree that surveillance for HCC should be indicated in patients with NAFLD/ MAFLD and cirrhosis but differ in non-cirrhotic patients (including those with advanced fibrosis). Several studies have shown that the annual incidence rate of HCC in NAFLD-cirrhosis is greater than 1%, thus surveillance for HCC is cost-effective. Risk factors that increase HCC incidence in these patients are male gender, older age, presence of diabetes and any degree of alcohol consumption. In non-cirrhotic patients, the incidence of HCC is much lower and variable, being a great challenge to stratify the risk of HCC in this group. Furthermore, large epidemiological studies based on the general population have shown that diabetes and obesity significantly increase risk of HCC. Some genetic variants may also play a role modifying the HCC occurrence among patients with NAFLD. The purpose of this review is to discuss the epidemiology, clinical and genetic risk factors that may influence the risk of HCC in NAFLD/MAFLD patients and propose screening strategy to translate into better patient care.
ABSTRACT
BACKGROUND & AIMS: Liver biopsy (LB) is the only means to evaluate fibrosis in NAFLD. Two scoring systems, NAFLD fibrosis score and BARD score, were proposed to separate cases with and without severe fibrosis (SF). Our aim was to compare the utility of both scores in patients with biopsy-proven NAFLD. METHODS: 138 consecutive patients of our series were included (67 male, median age 49 years). A NAFLD fibrosis score lower than -1.455 would exclude SF. A score greater than 0.676 would predict SF. An intermediate score is defined as indeterminate. The BARD score ranges from 0 to 4. Scores 0-1 are considered to have a high negative predictive value (NPV) for SF. The results of the scores were compared with LB staging. NPV, positive predictive value (PPV) and area under the ROC curve (AUROC) were calculated for both systems. RESULTS: A total of 37 patients had SF. NAFLD fibrosis score was indeterminate in 42 cases. Among the 91 patients with low score, 74 did not have SF but 17 patients had SF. All of 5 patients with a high score had SF. Sensitivity was 22.7%; specificity, 100%; NPV, 81.3%; and PPV, 100%. The BARD score was low in 96 patients and high in 42. Among the 96 patients with a low score, 78 did not have SF but 18 did. Among 42 patients with a high score, 19 had SF. Sensitivity was 51.4%; specificity, 77.2%; NPV, 81.3%; and PPV, 45.2%. AUROC were 0.68 (95% CI, 0.57-0.78) and 0.67 (95% CI, 0.56-0.77) for NAFLD fibrosis and BARD scores, respectively. CONCLUSIONS: Both systems were useful in identifying patients without SF (NPV 81.3%) but the BARD score is easier to estimate and does not have indeterminate results.
