In Gut, Chang et al1 investigated the role of metabolic dysfunction-associated steatotic liver disease (MASLD) in shaping hepatocellular carcinoma (HCC) risk after HCV cure. The residual risk of HCC following sustained virological response (SVR) represents a significant unmet need. In fact, although direct-acting antivirals (DAAs) effectively eradicate the virus, they do not fully eliminate oncogenic potential, particularly in patients who remain at risk. Identifying additional risk factors for HCC beyond HCV cure is crucial to better stratify patients, improve their clinical management and ensure appropriate follow-up. Early recognition of high-risk individuals not only allows timely diagnosis and access to curative HCC treatments but may ultimately alter the natural history of the disease and improve long-term outcomes.

The relative importance of the various risk factors for HCC beyond virological cure continues to evolve. Current international guidelines consistently recommend continued lifelong HCC surveillance after SVR in patients with advanced chronic liver…