Australians with metabolic dysfunction-associated steatotic liver disease have a twofold increase in the incidence of cancer

Elizabeth E Powell; Shruti Roche; Babak Sarraf; Gunter Hartel; Richard Skoien; Barbara Leggett; James O'Beirne; Patricia C Valery

doi:10.1002/jgh3.70000

Australians with metabolic dysfunction-associated steatotic liver disease have a twofold increase in the incidence of cancer

JGH Open. 2024 Jul 22;8(7):e70000. doi: 10.1002/jgh3.70000. eCollection 2024 Jul.

Authors

Elizabeth E Powell^{1

2

3}, Shruti Roche⁴, Babak Sarraf^{1

3}, Gunter Hartel³, Richard Skoien⁵, Barbara Leggett^{5

6}, James O'Beirne⁷, Patricia C Valery^{3

6}

Affiliations

¹ Department of Gastroenterology and Hepatology Princess Alexandra Hospital Woolloongabba Queensland Australia.
² Centre for Liver Disease Research, Faculty of Medicine the University of Queensland Brisbane Queensland Australia.
³ QIMR Berghofer Medical Research Institute Herston Queensland Australia.
⁴ Royal Brisbane and Women's Hospital Herston Queensland Australia.
⁵ Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Herston Queensland Australia.
⁶ Faculty of Medicine, The University of Queensland Woolloongabba Queensland Australia.
⁷ Department of Gastroenterology and Hepatology Sunshine Coast University Hospital Sunshine Coast Queensland Australia.

Abstract

Background and aim: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an increased risk of extrahepatic morbidity. We compared the incidence of cancers in adults admitted to Queensland hospitals with MASLD with that for the Queensland population and examined the association between cirrhosis and type 2 diabetes and the development of extrahepatic cancers.

Methods: In this retrospective study, we identified all cancers (Queensland Cancer Registry) after the first hospitalization with MASLD during Jul-2007 to Dec-2019, estimated age-standardized incidence (ASI) of cancers, and compared that with the ASI in the Queensland population (incidence rate ratios [IRR]). Among the MASLD cohort, we examined the association between diabetes and cancer risk (Cox regression). Median follow-up was 3.8 years (54 204 person-years).

Results: Totally 1104 new cancers were diagnosed in 1018 patients (8.9% of 9771 non-cirrhotic and 1712 adults with cirrhosis). The ASI (all cancers) of 1668.2 per 100 000 person-years in men (95% CI 1523.7-1827.4) and 1284.0 per 100 000 person-years in women (95% CI 1169.6-1408.2) was 2-fold higher than that of the Queensland population (IRR = 1.94, 95% CI 1.75-2.16 and IRR = 1.99, 95% CI 1.78-2.22, respectively). Incidence of stomach cancer, unknown primary, and pancreas was 3- to 5-fold higher compared to the general population (all P < 0.001). In multivariable analysis of the MASLD cohort, older age (e.g. ≥70 years adjusted hazard ratio [adj-HR] = 4.59, 95% CI 3.61-5.83), male gender (adj-HR = 1.20, 95% CI 1.05-1.37), and cirrhosis (adj-HR = 1.37, 95% CI 1.11-1.70) were independently associated with extrahepatic cancer risk, while diabetes was not.

Conclusions: Our findings will help to raise awareness among clinicians about the importance of cancer vigilance in this patient group.

Keywords: cirrhosis; diabetes; extrahepatic cancer; liver disease.