Outcomes of radiofrequency ablation for hepatocellular carcinoma with concurrent steatotic liver disease

Abstract Background Steatotic liver disease (SLD) is an emerging liver disease that has been associated with an increased risk for hepatocellular carcinoma (HCC). The impact of concurrent SLD on the prognosis of HCC remains unknown. This study investigates how concurrent SLD affects the outcomes of patients with HCC undergoing curative radiofrequency ablation (RFA) therapy. Methods A retrospective analysis of patients with early‐stage HCC receiving curative RFA at a tertiary medical center was conducted. Laboratory data and HCC characteristics were recorded and analyzed by a Cox proportional hazards regression model to predict recurrence and all‐cause mortality after RFA. Results A total of 598 patients with HCC were included between 2005 and 2015, with 139 and 459 classified in SLD and non‐SLD groups, respectively. The SLD group exhibited a significantly better liver reserve and a lower cumulative incidence of HCC recurrence and liver‐related and all‐cause mortality after a median follow‐up of 51 months. After adjusting for metabolic dysfunction, liver reserve, and HCC characteristics, the presence of SLD reduced all‐cause mortality (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.45–0.996; p = .048), which was supported by inverse probability weighting analysis (aHR, 0.65; 95% CI, 0.42–1.00; p = .049). Poor liver functional reserve (high albumin‐bilirubin grades) increased all‐cause mortality dose dependently. Barcelona Clinic Liver Cancer staging and a higher Fibrosis‐4 index were predictors for HCC recurrence, whereas SLD was not. Conclusions Among patients with HCC undergoing curative RFA, those with concurrent SLD had a lower risk of all‐cause mortality compared to those with poor liver functional reserve. Plain Language Summary The present research demonstrated that patients with both liver cancer and steatotic liver disease who received curative radiofrequency ablation for liver cancer survived longer compared to those without steatotic liver disease. Maintaining good liver function is an important prognostic factor for survival.