P3713 - Metabolic Liver Disease in HCC: Underdiagnosis and Advanced Portal Hypertension in Patients with a MASH-Consistent Phenotype in a Diverse Southwestern Cohort

Gicel J. Aguilar, BS, DO¹, Tomas Escobar Gil, MD¹, Mariana C. Perez Maldonado, BS², Alan G.. Ortega-Macias, MD¹, Erika Maestas, MD³, Euriko Torrazza Perez, MD, MSPH¹, Eric Lawitz, MD⁴
1University of New Mexico, Albuquerque, NM; 2Texas College of Osteopathic Medicine, San Antonio, TX; 3University of New Mexico Health Sciences Center, Albuquerque, NM; 4Texas Liver Institute, San Antonio, TX

Introduction: Metabolic dysfunction–associated steatohepatitis (MASH) is a growing driver of hepatocellular carcinoma (HCC), yet it remains underdiagnosed, especially in underserved populations. We evaluated the prevalence, clinical profile, and diagnostic workup of patients with a metabolic phenotype suggestive of MASH in a diverse cohort from the American Southwest.

Methods: We retrospectively analyzed clinical data from 260 patients with confirmed HCC diagnosed between 2015 and 2023 at the University of New Mexico Comprehensive Cancer Center. A metabolic phenotype consistent with MASH was defined as the presence of ≥2 of the following: obesity (BMI ≥30), type 2 diabetes, and dyslipidemia. We compared tumor and hepatic biomarkers—including AFP, Fib-4, albumin, platelet counts, and portal vein thrombosis (PVT)—between patients with and without this phenotype. We also assessed use of fibrosis assessment tools (biopsy, Fibroscan).

Results: Eighty-five patients (34.1%) met criteria for a MASH-consistent phenotype. Among them, only 6% underwent liver biopsy, and just one received Fibroscan evaluation. Use of GLP-1 receptor agonists or SGLT2 inhibitors was negligible. Patients with a MASH-consistent phenotype had significantly higher rates of PVT (p = 0.035), a marker of advanced portal hypertension. Mean platelet count were numerically lower in the MASH group (132.5 × 10³/µL) compared to the non-MASH group (145.0 × 10³/µL), (p = 0.27). No significant differences were observed in AFP (p = 0.20), Fib-4 score (p = 0.97), albumin (p = 0.24), or ECOG (p = 0.64). Native American patients had the highest prevalence of this phenotype (56%) but the lowest rates of fibrosis staging (biopsy 3%, Fibroscan 0%).

Discussion: Over one-third of HCC patients in this Southwestern cohort had a metabolic phenotype consistent with MASH, yet formal fibrosis assessment and therapeutic intervention were rare. These patients demonstrated higher rates of portal vein thrombosis and numerically lower platelet counts, suggesting later-stage disease at presentation. Improved recognition of metabolic liver disease and earlier non-invasive staging are critical for optimizing care in this growing HCC population.

Disclosures:
Gicel Aguilar indicated no relevant financial relationships.
Tomas Escobar Gil indicated no relevant financial relationships.
Mariana Perez Maldonado indicated no relevant financial relationships.
Alan Ortega-Macias indicated no relevant financial relationships.
Erika Maestas indicated no relevant financial relationships.
Euriko Torrazza Perez indicated no relevant financial relationships.
Eric Lawitz: 89 Bio INC – Consultant, Grant/Research Support, Speakers Bureau. Abbvie – Speakers Bureau. Akero Therapeitics – Grant/Research Support. Alnylam Phamaceuticals INC – Grant/Research Support. Amgen – Grant/Research Support. Aztrazeneca – Consultant, Grant/Research Support. Bioscience – Grant/Research Support. Boehringer Ingelheim – Consultant, Grant/Research Support. Bristol-Myers Squibb – Grant/Research Support. Corcept Therapeutics – Consultant, Grant/Research Support. Cour Pharmaceuticals Inc – Grant/Research Support. Cymabay Therapeutics – Grant/Research Support. Eli Lily and Company – Consultant, Grant/Research Support. Enanta Pharmaceuticals – Grant/Research Support. Enyo Pharma – Grant/Research Support. Exalenz – Grant/Research Support. Galectin Therapeutics – Grant/Research Support. Galmed Pharmaceuticals – Grant/Research Support. Genfit – Grant/Research Support. Gilead Sciences – Grant/Research Support, Speakers Bureau. GlaxoSmithKline – Grant/Research Support. Hanmi Pharmaceuticals – Grant/Research Support. Hightide Biopharma – Grant/Research Support. Intercept Pharmaceuticals – Grant/Research Support, Speakers Bureau. Inventiva – Grant/Research Support. Ipsen – Grant/Research Support. Jansen Pharmaceuticals – Grant/Research Support. Madrigal Pharmaceuticals – Grant/Research Support, Speakers Bureau. Merck & Co – Consultant, Grant/Research Support. NGM Biopharmaceuticals Inc – Grant/Research Support. Northsea Therapeutics – Grant/Research Support. Novartis – Grant/Research Support. Novo Nordisk Inc – Consultant, Grant/Research Support. Organovo – Consultant, Grant/Research Support. Poxel Co – Grant/Research Support. Regeneron – Consultant, Grant/Research Support. Sagimet Biosciences – Consultant, Grant/Research Support. Takeda – Grant/Research Support. Terns pharmaceuticals – Grant/Research Support. Viking Therapeutics – Grant/Research Support. Zydus Pharmaceuticals – Grant/Research Support.

Gicel J. Aguilar, BS, DO¹, Tomas Escobar Gil, MD¹, Mariana C. Perez Maldonado, BS², Alan G.. Ortega-Macias, MD¹, Erika Maestas, MD³, Euriko Torrazza Perez, MD, MSPH¹, Eric Lawitz, MD⁴. P3713 - Metabolic Liver Disease in HCC: Underdiagnosis and Advanced Portal Hypertension in Patients with a MASH-Consistent Phenotype in a Diverse Southwestern Cohort, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.