肝细胞癌 (HCC) 正在经历一场变革，代谢相关脂肪肝病 (MAFLD) 正在成为主要病因。 MAFLD 的诊断标准涉及肝脂肪变性和代谢失调。在全球范围内，MAFLD 患病率为 38.77%，与肥胖率上升密切相关。流行病学数据表明，肝细胞癌（HCC）的主要病因发生了动态变化，从病毒性肝病转变为代谢性肝病。除了肝纤维化程度外，一些可改变的生活方式危险因素，如2型糖尿病、肥胖、饮酒、吸烟以及HBV、HCV感染也会导致HCC的发病。此外，肠道微生物群和遗传变异可能有助于 HCC 的发展。MAFLD 和 HCC 之间的病理生理联系涉及代谢失调、葡萄糖和脂质代谢受损、炎症和氧化应激。无声表现给早期 MAFLD-HCC 诊断带来了挑战。影像学、活检和人工智能辅助技术有助于诊断，而非肝硬化 MAFLD 患者的 HCC 监测仍存在争议。ITA.LI.CA。该小组提出了一种基于巴塞罗那诊所肝癌 (BCLC) 算法的基于生存的治疗算法。根据疾病阶段应用肝切除、移植、消融和局部治疗。全身治疗是有希望的，初步免疫治疗结果表明 MAFLD 相关 HCC 的反应较差。采用生活方式干预和药物化学预防措施，包括阿司匹林、二甲双胍和他汀类药物，构成 HCC 一级预防的有前途的方法。预后受到影响受多种因素影响，MAFLD-HCC 与延长生存期相关。新兴的诊断生物标志物和表观基因组标志物在 MAFLD 人群的早期 HCC 检测方面显示出有希望的结果。© 2024。亚太肝脏研究协会。

Hepatocellular carcinoma (HCC) is undergoing a transformative shift, with metabolic-associated fatty liver disease (MAFLD) emerging as a dominant etiology. Diagnostic criteria for MAFLD involve hepatic steatosis and metabolic dysregulation. Globally, MAFLD prevalence stands at 38.77%, significantly linked to the escalating rates of obesity. Epidemiological data indicate a dynamic shift in the major etiologies of hepatocellular carcinoma (HCC), transitioning from viral to metabolic liver diseases. Besides the degree of liver fibrosis, several modifiable lifestyle risk factors, such as type 2 diabetes, obesity, alcohol use, smoking, and HBV, HCV infection contribute to the pathogenesis of HCC. Moreover  gut microbiota and genetic variants may contribute to HCC development.The pathophysiological link between MAFLD and HCC involves metabolic dysregulation, impairing glucose and lipid metabolism, inflammation and oxidative stress. Silent presentation poses challenges in early MAFLD-HCC diagnosis. Imaging, biopsy, and AI-assisted techniques aid diagnosis, while HCC surveillance in non-cirrhotic MAFLD patients remains debated.ITA.LI.CA. group proposes a survival-based algorithm for treatment based on Barcelona clinic liver cancer (BCLC) algorithm. Liver resection, transplantation, ablation, and locoregional therapies are applied based on the disease stage. Systemic treatments is promising, with initial immunotherapy results indicating a less favorable response in MAFLD-related HCC.Adopting lifestyle interventions and chemopreventive measures with medications, including aspirin, metformin, and statins, constitute promising approaches for the primary prevention of HCC.Prognosis is influenced by multiple factors, with MAFLD-HCC associated with prolonged survival. Emerging diagnostic biomarkers and epigenomic markers, show promising results for early HCC detection in the MAFLD population.© 2024. Asian Pacific Association for the Study of the Liver.