P111: Navigating Disease Nomenclature Changes: Trends and Gaps in NAFLD/NASH-Related Hepatocellular Carcinoma Research
Poster Presenter
Xianwen Chen
Student
University of Macau Macao
Objectives
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) increasingly drive hepatocellular carcinoma (HCC) globally. This study analyzes trends and gaps in NAFLD/NASH-related HCC research, focusing on the impact of nomenclature shifts.
Method
We searched Embase, PubMed, Web of Science, and Scopus for studies on NAFLD/NASH-related HCC, excluding reviews and non-English papers. Included studies were analyzed for publication trends, country distribution, disease type, research content, and surveillance focus using descriptive statistics.
Results
This systematic review initially retrieved 11,217 records, with 172 studies (2002–2025) included after screening. Of these, 52.6% (91/172) were published post-2020, with a 68.8% rise from 2020 (16 studies) to 2025 (projected 27), showing a temporal trend (R²=0.92). The USA led publications with 57 studies (33.14%), followed by Japan (22, 12.79%), South Korea (12, 6.89%), China (12, 6.89%), and Italy (7, 4.07%), collectively accounting for 63.95%. Study data sites were mostly from the USA (32.56%), Japan (12.79%), South Korea (6.40%), China (5.81%), and Taiwan (3.49%), with global studies at 2.91%.
Time periods were divided based on nomenclature changes: NAFLD to MAFLD (Metabolic dysfunction associated fatty liver disease) in 2020 and NASH to MASH (Metabolic dysfunction-associated steatohepatitis) with MASLD (Metabolic dysfunction–associated steatotic liver disease) introduction in 2023. Studies primarily targeted NAFLD-related HCC (42.44%) and NASH-related HCC (37.21%), totaling 79.65%. Post-2020, MAFLD-related HCC accounted for 9.88% and MASLD-related HCC for 3.49%. Combined disease studies (e.g., NASH/NAFLD-related HCC) comprised 4.07%. Studies on MASH-related HCC were limited (0.58%).
Research content analysis showed epidemiological distribution studies as most common (24.42%), followed by risk factors (15.12%). Clinical studies on therapeutics and prognosis each comprised 13.95%, and phenotype studies 10.47%. Integrative studies combining categories accounted for 15.70%. Pre-2020, 75 studies were published, dropping to 44 from 2023 onward.
Of the 172 studies, 138 (80.23%) did not report surveillance-related content. Surveillance-related studies comprised 20% (34/172). Of these, 21 (61.76%) reported surveillance effectiveness, 12 (35.29%) reported only the number of participants under surveillance, and 1 (2.94%) reported both effectiveness and cost, indicating a gap in structured screening efforts.
Conclusion
The notable rise in NAFLD/NASH-related HCC research post-2020 reflects increasing academic attention, supported by a strong temporal trend. Concentration in the USA and Asian countries suggests regional research capacity, yet broader global efforts are needed to tackle this growing challenge comprehensively.
The predominance of NAFLD- and NASH-related HCC studies over newer terms like MAFLD and MASLD indicates a slow adoption of updated nomenclature, potentially due to non-harmonized disease terminology in some regions.
Clinical and epidemiological studies have progressed, mirroring shifts in research priorities within the field. Nevertheless, following the recent nomenclature revision, further scientific investigations are required to update and expand the evidence base concerning the clinical characteristics and epidemiology of MASLD-related diseases.
Limited surveillance-related studies reveal a critical gap in systematic screening for NAFLD/NASH-related HCC, often complicated by non-cirrhotic presentations. This risks delayed diagnoses, underscoring the need for targeted strategies to enhance early detection.
To combat NASH/NAFLD-related HCC, standardized disease definition is crucial to translate findings into effective clinical applications, ultimately optimizing disease management and patient outcomes. The clinical application of new nomenclatures or classifications can be advanced by integrating evidence from key research findings. Clinical guidelines should be updated promptly with clear diagnostic criteria. Scientifically, standardizing disease definition presentation is essential for consistent research and evidence dissemination. At the regulatory level, a clear review process for named or new nomenclature data and evidence is needed. Additionally, patient management should combine education and multidisciplinary collaboration (e.g., metabolic, obesity, and liver disease units) to enhance public awareness and acceptance of the new nomenclature.
