Impact of steatotic liver disease on hepatitis B related hepatocellular carcinoma: MRI manifestation and prognostic potential.

Objectives: To investigate the impact of steatotic liver disease (SLD) on hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) in clinical and MRI manifestations and prognostic potential.

Methods: 441 HBV-related HCC patients were retrospectively enrolled (mean age 55.5 years ±10.8, 366 males, 237 without and 204 with concurrent SLD). Kaplan-Meier analyses were performed to compare the overall survival (OS) and recurrence-free survival (RFS). Clinical and MRI characteristics were compared. Univariate and multivariate analyses were used to identify the different imaging features between patients with and without concurrent SLD.

Results: Patients with concurrent SLD had a better OS (P = 0.047). Except for metabolism-related indicators, the level of alpha fetoprotein (Z = 7.82, P = 0.007), the grade of tumor lesion (χ2= 6.567, P = 0.035) and microvascular invasion (χ2= 6.252, P = 0.044) appeared to be lower in patients with SLD. According to the multivariate analysis, non-adjacent to porta hepatis or confluence of hepatic veins (odds ratio [OR]=1.624, P = 0.041), absent washout appearance (OR = 2.047, P = 0.001) and intact enhancing capsule (OR = 2.584, P = 0.003) were significantly different MRI manifestations between tumors with and without SLD.

Conclusions: For HBV-related HCC, concurrent SLD tended to be associated with better OS. The clinical and radiological characteristics were different, which seemed to be less aggressive for those with concurrent SLD.

Advances in knowledge: Concurrent SLD in HBV-related HCC patients may be associated with better overall survival, and it exhibits distinct clinical and radiological features, which seem to be less aggressive.