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Abstract：
OBJECTIVE: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study.
METHODS: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD.
RESULTS: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4).
CONCLUSIONS: Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.
METHODS: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD.
RESULTS: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4).
CONCLUSIONS: Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.
摘要：
目的：最近提出代谢功能障碍相关的脂肪变性肝病（MASLD）作为非酒精性脂肪性肝病（NAFLD）的替代疾病概念。我们旨在使用多中心研究的数据调查活检证实的MASLD患者的预后。
方法：这是CLIONE（临床结果非酒精性脂肪性肝病）研究的子分析，纳入1,398例NAFLD患者。肝活检标本经病理诊断，并使用NASH临床研究网络系统进行组织学评分。符合至少一个心脏代谢标准的患者被诊断为MASLD。
结果：大约99%的病例（n=1,381）被归类为MASLD。没有任何心脏代谢风险的患者（n=17）的BMI明显低于MASLD患者（28.0vs.20.9kg/m2,P<0.001),炎症水平明显降低，气球，NAFLD活动评分,和肝组织学纤维化阶段。这17名患者的中位随访时间为5.9年，相当于115人年，没有死亡,肝脏相关事件,心血管事件,或者肝外癌症。结果显示，纯MASLD的预后与原始CLIONE队列相似，47人死亡,1例患者行原位肝移植。死亡的主要原因是肝外癌（n=10）。肝脏相关死亡的主要原因是肝衰竭（n=9），肝细胞癌（n=8），和胆管细胞癌（n=4）。
结论：大约99%的NAFLD病例对应于MASLD。仅NAFLD组,这不包括在MASLD中，组织病理学严重程度相对较轻，预后良好。因此,MASLD的预后与NAFLD相似.
方法：这是CLIONE（临床结果非酒精性脂肪性肝病）研究的子分析，纳入1,398例NAFLD患者。肝活检标本经病理诊断，并使用NASH临床研究网络系统进行组织学评分。符合至少一个心脏代谢标准的患者被诊断为MASLD。
结果：大约99%的病例（n=1,381）被归类为MASLD。没有任何心脏代谢风险的患者（n=17）的BMI明显低于MASLD患者（28.0vs.20.9kg/m2,P<0.001),炎症水平明显降低，气球，NAFLD活动评分,和肝组织学纤维化阶段。这17名患者的中位随访时间为5.9年，相当于115人年，没有死亡,肝脏相关事件,心血管事件,或者肝外癌症。结果显示，纯MASLD的预后与原始CLIONE队列相似，47人死亡,1例患者行原位肝移植。死亡的主要原因是肝外癌（n=10）。肝脏相关死亡的主要原因是肝衰竭（n=9），肝细胞癌（n=8），和胆管细胞癌（n=4）。
结论：大约99%的NAFLD病例对应于MASLD。仅NAFLD组,这不包括在MASLD中，组织病理学严重程度相对较轻，预后良好。因此,MASLD的预后与NAFLD相似.
