HCC Is the Predominant Liver-Related Event in MASLD: 2-Step Non-Invasive Algorithms to Stratify Risk in Non-Cirrhotic Patients

Background & Aims: Hepatocellular carcinoma (HCC) may develop in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) even in the absence of cirrhosis. Whether the risk of HCC in non-cirrhotic MASLD is substantial to justify surveillance, and which patients may benefit, remains unclear. Methods: Post-hoc analysis conducted on a prospective MASLD cohort. All participants underwent baseline liver stiffness measurement (LSM) using SuperSonic Imagine (SSI) two-dimensional shear wave elastography (2D-SWE) and were surveilled every 6-12 months. Exclusion criteria were less than 6 months follow-up, unavailable LSM-SSI, prior HCC. Primary outcome was HCC, with hepatic decompensation and portal vein thrombosis (PVT) as competing risks. To improve risk stratification, LSM-SSI optimized cut-offs were applied: