Machine Learning-Based Assessment of Survival and Risk Factors in Non-Alcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma for Optimized Patient Management

Abstract

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an incidence that is exponentially increasing. Hepatocellular carcinoma (HCC) is the most frequent primary tumor. There is an increasing relationship between these entities due to the potential risk of developing NAFLD-related HCC and the prevalence of NAFLD. There is limited evidence regarding prognostic factors at the diagnosis of HCC. This study compares the prognosis of HCC in patients with NAFLD against other etiologies. It also evaluates the prognostic factors at the diagnosis of these patients. For this purpose, a multicenter retrospective study was conducted involving a total of 191 patients. Out of the total, 29 presented NAFLD-related HCC. The extreme gradient boosting (XGB) method was employed to develop the reference predictive model. Patients with NAFLD-related HCC showed a worse prognosis compared to other potential etiologies of HCC. Among the variables with the worst prognosis, alcohol consumption in NAFLD patients had the greatest weight within the developed predictive model. In comparison with other studied methods, XGB obtained the highest values for the analyzed metrics. In conclusion, patients with NAFLD-related HCC and alcohol consumption, obesity, cirrhosis, and clinically significant portal hypertension (CSPH) exhibited a worse prognosis than other patients. XGB developed a highly efficient predictive model for the assessment of these patients.

Prognostic Impact of Metabolic Syndrome and Steatotic Liver Disease in Hepatocellular Carcinoma Using Machine Learning Techniques

“…An estimated 10% of patients with MASLD are projected to experience complications associated with chronic liver disease throughout their lifetime, with the emergence of HCC being the most severe [ 69 ]. Most of these tumors arise in cirrhotic livers, with an estimated annual risk of developing HCC in patients with cirrhosis secondary to MASLD being approximately 2%.…”

“…Alcohol intake, regardless of quantity, promotes the development of hepatic steatosis, increases serum urate levels, and elevates blood pressure. On the other hand, alcohol is one of the etiologies of HCC most strongly associated with the development of cirrhosis, which would result in a poorer prognosis for these patients [ 69 , 74 ]. Other factors associated with lower survival include higher scores on the Child–Pugh classification and age, which would hinder the application of curative treatments.…”