Steatosis, HBV‐related HCC, cirrhosis, and HBsAg seroclearance: A systematic review and meta‐analysis

Background and Aims: NAFLD and chronic hepatitis B (CHB) infection are common etiologies of HCC. The impact of hepatic steatosis on HCC in CHB, as well as its relationship with the development of cirrhosis, fibrosis, and HBsAg seroclearance, remains controversial. Approach and Results: Data from observational studies were collected through PubMed, EMBASE, and the Cochrane Library from inception to February 1, 2022. Outcomes of interest included the association of hepatic steatosis with HCC, cirrhosis, advanced fibrosis, and HBsAg seroclearance, expressed in terms of pooled ORs. Additional subgroup and sensitivity analyses were performed to validate the robustness of findings. A total of 34 studies with 68,268 patients with CHB were included. Hepatic steatosis was associated with higher odds of HCC (OR, 1.59; 95% CI, 1.12–2.26; I 2 = 72.5%), with the association remaining consistent in Asia (OR, 1.56; 95% CI, 1.08–2.25), studies with a median follow‐up duration of ≥5 years (OR, 2.82; 95% CI, 1.57–5.08), exclusion of alcohol use (OR, 1.71; 95% CI, 1.01–2.91), and biopsy‐proven steatosis (OR, 2.86; 95% CI, 1.61–5.06), although no significant association was noted among nucleos(t)ide analogue–treated patients (OR, 1.05; 95% CI, 0.62–1.77). Steatosis was associated with the development of cirrhosis (OR, 1.52; 95% CI, 1.07–2.16; I 2 = 0%) and HBsAg seroclearance (OR, 2.22; 95% CI, 1.58–3.10; I 2 = 49.0%). Conclusions: Hepatic steatosis was associated with an increased risk of HCC and cirrhosis among patients with CHB but with a higher chance of achieving a functional cure, highlighting the importance of identifying concomitant steatosis in CHB.