Backgrounds/Aims Non-B non-C hepatocellular carcinoma (NBNC-HCC) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). We examined whether etiology is associated with recurrence after curative-intent ablation. Methods We retrospectively analyzed 129 consecutive patients who underwent curative-intent ablation (with neoadjuvant transarterial chemoembolization in 36%) between 2011 and 2024 (MASLD 47; MetALD 21; ALD 61) after excluding two unclassifiable patients. Alcohol intake was categorized pragmatically as <=20, >20-60, or >60 g/day irrespective of sex, and the primary comparison was MASLD versus ALD. First recurrence was analyzed with a Fine-Gray model, treating death without recurrence as a competing event. Results MASLD carried a lower recurrence hazard than ALD (adjusted subdistribution hazard ratio [sHR] 0.46, 95% CI 0.23-0.90; p=0.023). The association was present before adjustment (sHR 0.59; p=0.043) and strengthened after age adjustment, indicating negative confounding by age. Cause-specific and recurrence-free survival analyses were concordant. In exploratory analyses, local tumor progression showed no clear etiologic difference, whereas non-local recurrence was lower in MASLD (adjusted sHR 0.48; p=0.010); MetALD and ALD did not differ. Conclusions A metabolic (MASLD) rather than alcohol-related (ALD) etiology was associated with lower post-ablation recurrence, localized to non-local rather than local recurrence. Given the pragmatic classification, follow-up imbalance, and possible residual confounding, this finding is hypothesis-generating and requires confirmation in larger, multicenter cohorts.
Background/Aims Surgical resection and percutaneous ablation are considered curative treatments for hepatocellular carcinoma (HCC). However, both approaches are associated with a high risk of recurrence. Real-world data on outcomes and post-curative management remain scarce. This study aimed to assess survival and healthcare pathways of patients with HCC treated with resection or ablation in routine clinical practice. Methods We conducted a retrospective analysis using the French National Health Data System. Patients who underwent resection or percutaneous ablation as first-line treatment for HCC between January 2014 and December 2021 were included. The primary endpoint was overall survival (OS); secondary endpoints focused on subsequent treatment sequences and healthcare pathways Results Among 10,810 patients included, 5,488 underwent ablation and 5,322 resection as first-line treatment. One- and 2-year OS rates were 90% and 78% after ablation (median OS [mOS], 56 months; 95% confidence interval [CI], 54–58) and 88% and 80% after resection (mOS, 75 months; 95% CI, 72–79). Median time to next treatment or death was 20 months (95% CI, 18–21) after ablation and 29 months (95% CI, 27–30) after resection. Following initial treatment, 27% of patients in the ablation group and 39% in the resection group received no further therapy. Conclusions This nationwide real-world study provides comprehensive data on survival and treatment sequences after curative-intent therapy for HCC in France. Despite frequent recurrence, survival outcomes remained favourable, reflecting access to repeated and effective subsequent treatments, underscoring the importance of long-term follow-up in routine care.
