Supplementary Material for: The Risk of Decompensation in Steatotic Liver Disease Related Hepatocellular Carcinoma: A Comparison with Viral-controlled Cases

Background and Aims: Treatment options for steatotic liver disease (SLD) are limited compared to those for viral hepatitis, which may affect the prognosis of patients with hepatocellular carcinoma (HCC).
Methods: This retrospective cohort study included 255 and 125 patients with SLD-related HCC and viral-controlled HCC (80 hepatitis C and 45 hepatitis B) who underwent curative radiofrequency ablation (RFA) for primary HCC (maximum tumor diameter ≤ 3 cm and ≤3 lesions). Viral control was defined as a sustained virological response to hepatitis C and undetectable hepatitis B viruses on a nucleos(t)ide analog before HCC diagnosis. Overall survival, recurrence rates, and hepatic decompensation rates were evaluated using the Kaplan-Meier method and Cox proportional hazard models between the two groups. Validation was performed in a surgical cohort of 120 patients (70 with SLD and 50 controls).
Results: The 1-, 3-, and 5-year survival rates were 97%, 81%, and 62% for patients with SLD-related HCC, and 100%, 94%, and 89% for viral-controlled patients in the RFA cohort, respectively (p < 0.001, log-rank test). Multivariate analysis showed no significant difference in recurrence between the two groups (adjusted hazard ratio [aHR] 1.06, p = 0.75); however, a higher risk of hepatic decompensation was observed in patients with SLD-related HCC (aHR 6.17; p <0.001) and a worse overall survival (aHR 2.04; p = 0.003). Similar results were observed in the surgical cohort.
Conclusion: Patients with SLD-related HCC have a higher risk of decompensation than viral-controlled patients with HCC, which leads to a worse overall survival.