Doctors now have a new tool to help find out which patients with chronic liver disease are most likely to develop liver cancer.
A scoring system called the SAFE score uses common medical information to predict risk. This means doctors can better decide who needs regular check-ups to catch liver cancer early, even if they don’t have hepatitis or cirrhosis.
Liver cancer, especially a type called hepatocellular carcinoma (HCC), is one of the most deadly cancers in the world. It’s the third leading cause of cancer-related death. Right now, doctors mainly focus on people with chronic hepatitis B or C, or people with liver cirrhosis, when deciding who needs regular liver cancer screening.
But many people with liver cancer don’t have those conditions—especially those with liver problems caused by fat buildup, called metabolic dysfunction-associated steatotic liver disease (MASLD).
This leaves a big gap. Many people with liver diseases like MASLD are not included in current cancer screening guidelines, even though they can still get liver cancer. In fact, studies show that about 4 in 10 people with MASLD-related liver cancer do not have cirrhosis. That means they might not be getting the check-ups they need.
To help solve this problem, researchers at National Taiwan University created the SAFE score. It stands for Steatosis-Associated Fibrosis Estimator. The SAFE score uses simple information that doctors already collect during regular visits.
It includes a person’s age, body mass index (BMI), whether they have diabetes, and results from common blood tests like liver enzyme levels (AST and ALT), platelet count, and globulin levels.
The study followed nearly 13,000 patients with chronic liver disease over about four years. The results showed that the SAFE score was a strong and accurate way to predict who would develop liver cancer.
People with a SAFE score of 100 or more had a much higher risk—7.5 times higher—than those with a lower score. The score worked well for many types of liver disease, not just hepatitis. In MASLD patients, a high SAFE score meant a 4.2 times higher risk, and in people with non-viral liver disease, it meant an 11.1 times higher risk.
To make sure their results were accurate, the researchers tested the SAFE score in two other large groups of people. One was a different hospital group, and the other was a huge community group of over 120,000 people with MASLD. The score worked well in both cases, showing it is reliable in many settings.
This discovery is important because it helps doctors find high-risk patients who might have been missed under current guidelines. The SAFE score could lead to more people being screened regularly, which might help catch liver cancer earlier when it’s easier to treat.
Even people who already have hepatitis and are taking medicine for it can benefit from this score. The SAFE score helps show whether their risk of liver cancer is still high. It also helps doctors know which patients have a very low risk, so they might not need as much monitoring.
Prof. Jia-Horng Kao, one of the study’s lead authors, said this tool fills a big gap in liver care. Prof. Tung-Hung Su, another author, said the SAFE score gives people with conditions like MASLD a better way to check if they are at risk for liver cancer and start early screenings.
The results of this study were published in the journal Clinical and Molecular Hepatology. The SAFE score may become a simple but powerful way to help save lives by finding liver cancer earlier in more people.
If you care about liver health, please read studies about simple habit that could give you a healthy liver, and common diabetes drug that may reverse liver inflammation.
For more information about health, please see recent studies about simple blood test that could detect your risk of fatty liver disease, and results showing this green diet may strongly lower non-alcoholic fatty liver disease.
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