Extrahepatic cancers have been recognized as a significant outcome of metabolic dysfunction–associated steatotic liver disease (MASLD), which involves five cardiometabolic risk factors, including hypertension, and is associated with the tumorigenesis of several cancers or with anti-cancer treatment. We aimed to investigate the association between hypertension, liver fibrosis, and extrahepatic cancers in the MASLD population.
Methods
This multicenter cross-sectional study was based on a MASLD population from hospital-based databases across 11 centers nationwide in China, according to MASLD diagnostic criteria identified using keywords and ICD-10 codes. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between risk factors and extrahepatic cancers.
Results
A total of 103,652 individuals with MASLD were identified, among whom 6,605 were diagnosed with extrahepatic cancers. The primary outcome revealed that hypertension was significantly associated with extrahepatic cancers (OR 1.14, 95% CI: 1.08–1.21), and its combination with hyperglycemia further increased this association (OR 1.36, 95% CI: 1.22–1.51). Risk factors for extrahepatic cancers included being over 40 years of age and female sex. Conversely, certain metabolism-based treatments were found to have potentially protective effects, including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, fibrates, GLP-1 receptor agonists, and thiazolidinediones. After adjusting for confounding factors, the fibrosis-4 (FIB-4) score was associated with extrahepatic cancers. In the hypertension subgroup, FIB-4 scores of 1.30–2.66, 2.67–3.47, and ≥ 3.48 were associated with extrahepatic cancers in individuals aged 35–64 years, consistent with findings in those aged ≥ 65 years of age with FIB-4 ≥ 2.
Conclusions
A total of 6,605 individuals with extrahepatic cancers were identified from a population of 103,652 patients with MASLD. Hypertension and the combination of hypertension and hyperglycemia were significantly associated with extrahepatic cancers. This association was further supported by the finding that metabolism-based treatments might be significantly linked to a protective role in the MASLD population. The association was observed in individuals with FIB-4 scores ≥ 1.3 among those aged 35 to 65 years and ≥2.0 among those aged over 65 years. Individuals with MASLD over 40 years of age may be recommended for extrahepatic cancer screening, especially those with hypertension and FIB-4 scores ≥ 1.3.
Full text
https://www.xiahepublishing.com/2310-8819/JCTH-2025-00423
The study was recently published in the Journal of Clinical and Translational Hepatology .
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