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Background <p>Both alcohol fatty liver disease (AFLD) and non-alcohol fatty liver disease (NAFLD) are established risk factors for liver cancer development. We conduct a comparative analysis between AFLD and NAFLD to determine which condition contributes a greater burden to liver cancer incidence.</p> Methods <p>Data were obtained from the TriNetX research network. Individuals aged ≥ 20 years with newly diagnosed fatty liver disease between 2008 and 2021 were included. Participants were categorized into two groups: AFLD and NAFLD. Patients with a history of hepatic cirrhosis, liver cancer, hepatitis B, or hepatitis C before the index date were excluded. Propensity score matching was performed based on age, sex, and comorbidities, resulting in a balanced 1:1 matched cohort. Comparative analyses were conducted between the AFLD and NAFLD cohorts to assess differences in liver cancer risk profiles.</p> Results <p>A total of 13,998 AFLD and 1,165,365 NAFLD cases were analyzed. After propensity score matching, both cohorts consist of 13,998 individuals. At the 2- and 3-year follow-ups, the risk became statistically significant and showed a progressive increase, with relative risks approaching a two-fold elevation in the AFLD group. Cumulatively, by the final follow-up, AFLD patients demonstrated a markedly higher incidence of liver cancer (0.950% vs. 0.493%), confirming a sustained and significantly elevated risk even after adjustment for baseline characteristics.</p> Conclusion <p>Patients with AFLD exhibited an approximately two-fold increased risk of liver cancer development over a 3-year follow-up period compared to those with NAFLD. This finding underscores the urgent need for comprehensive recognition and mitigation of alcohol-associated hepatocarcinogenesis.</p>

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A Higher Risk of Liver Cancer in Alcoholic Fatty Liver Disease than in Non-Alcoholic Fatty Liver Disease: an Analysis of the TriNetX Dabatase

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Ling-Hui Chang,
  • Sheng-You Su,
  • Chun Lee,
  • Chao-Yu Hsu

摘要

Background

Both alcohol fatty liver disease (AFLD) and non-alcohol fatty liver disease (NAFLD) are established risk factors for liver cancer development. We conduct a comparative analysis between AFLD and NAFLD to determine which condition contributes a greater burden to liver cancer incidence.

Methods

Data were obtained from the TriNetX research network. Individuals aged ≥ 20 years with newly diagnosed fatty liver disease between 2008 and 2021 were included. Participants were categorized into two groups: AFLD and NAFLD. Patients with a history of hepatic cirrhosis, liver cancer, hepatitis B, or hepatitis C before the index date were excluded. Propensity score matching was performed based on age, sex, and comorbidities, resulting in a balanced 1:1 matched cohort. Comparative analyses were conducted between the AFLD and NAFLD cohorts to assess differences in liver cancer risk profiles.

Results

A total of 13,998 AFLD and 1,165,365 NAFLD cases were analyzed. After propensity score matching, both cohorts consist of 13,998 individuals. At the 2- and 3-year follow-ups, the risk became statistically significant and showed a progressive increase, with relative risks approaching a two-fold elevation in the AFLD group. Cumulatively, by the final follow-up, AFLD patients demonstrated a markedly higher incidence of liver cancer (0.950% vs. 0.493%), confirming a sustained and significantly elevated risk even after adjustment for baseline characteristics.

Conclusion

Patients with AFLD exhibited an approximately two-fold increased risk of liver cancer development over a 3-year follow-up period compared to those with NAFLD. This finding underscores the urgent need for comprehensive recognition and mitigation of alcohol-associated hepatocarcinogenesis.