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Background <p>Steatotic liver disease (SLD) has emerged as a heterogeneous condition with distinct subtypes defined by metabolic dysfunction and alcohol exposure. We aimed to investigate the associations of SLD subtypes—metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with elevated alcohol intake (MetALD), and alcohol-related liver disease (ALD)—with the risk of gastric cancer (GC) and esophageal cancer (EC) in a nationwide cohort.</p> Methods <p>We analyzed a cohort of 362,285 individuals aged ≥ 40 years using the Korean National Health Insurance Service claims data. Participants underwent screening in 2009–2010 with follow-up through 2019. They were categorized into no SLD, MASLD, MetALD, or ALD. Cox proportional hazards models adjusted for demographic, clinical, and lifestyle factors estimated hazard ratios (HRs) for GC and EC. Subgroup analyses were conducted by alcohol intake levels and cardiometabolic burden.</p> Results <p>Over 10 years, 4,842 participants (1.98%) developed GC or EC. The risk of GC increased progressively across SLD subtypes, with HRs of 1.09 (95% CI: 1.02–1.16) for MASLD, 1.31 (1.16–1.48) for MetALD, and 1.40 (1.16–1.68) for ALD. For EC, MASLD was not significant associated (HR 0.81, 95% CI: 0.63–1.05), whereas risks were significantly elevated in MetALD (1.68, 1.17–2.42) and ALD (2.18, 1.36–3.49).</p> Conclusions <p>GC risk is modestly increased in MASLD and more pronounced in alcohol-related SLD subtypes, whereas EC risk is primarily driven by alcohol exposure. These findings indicate that GC is influenced by both metabolic dysfunction and alcohol, while alcohol plays the predominant role in EC.</p>

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Subtype-specific associations of steatotic liver disease with gastric and esophageal cancers: a nationwide cohort study

  • 期刊论文

  • 发表日期：

    2026年1月13日

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  • Yeo Wool Kang,
  • Minkook Son,
  • Jong Yoon Lee,
  • Sang Yi Moon,
  • Myeongseok Koh

摘要

Background

Steatotic liver disease (SLD) has emerged as a heterogeneous condition with distinct subtypes defined by metabolic dysfunction and alcohol exposure. We aimed to investigate the associations of SLD subtypes—metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with elevated alcohol intake (MetALD), and alcohol-related liver disease (ALD)—with the risk of gastric cancer (GC) and esophageal cancer (EC) in a nationwide cohort.

Methods

We analyzed a cohort of 362,285 individuals aged ≥ 40 years using the Korean National Health Insurance Service claims data. Participants underwent screening in 2009–2010 with follow-up through 2019. They were categorized into no SLD, MASLD, MetALD, or ALD. Cox proportional hazards models adjusted for demographic, clinical, and lifestyle factors estimated hazard ratios (HRs) for GC and EC. Subgroup analyses were conducted by alcohol intake levels and cardiometabolic burden.

Results

Over 10 years, 4,842 participants (1.98%) developed GC or EC. The risk of GC increased progressively across SLD subtypes, with HRs of 1.09 (95% CI: 1.02–1.16) for MASLD, 1.31 (1.16–1.48) for MetALD, and 1.40 (1.16–1.68) for ALD. For EC, MASLD was not significant associated (HR 0.81, 95% CI: 0.63–1.05), whereas risks were significantly elevated in MetALD (1.68, 1.17–2.42) and ALD (2.18, 1.36–3.49).

Conclusions

GC risk is modestly increased in MASLD and more pronounced in alcohol-related SLD subtypes, whereas EC risk is primarily driven by alcohol exposure. These findings indicate that GC is influenced by both metabolic dysfunction and alcohol, while alcohol plays the predominant role in EC.