The Prevalence and Associated Factors of Simple Hepatic Cysts in Shanghai

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The Prevalence and Associated Factors of Simple Hepatic Cysts in Shanghai: A Population-Based Cross-Sectional Study

Introduction

Simple hepatic cysts are among the most common benign liver lesions encountered in clinical practice. While the majority of cases follow an asymptomatic course, complications such as infection, hemorrhage, rupture, or compression of adjacent organs can lead to significant morbidity. Despite their clinical relevance, existing epidemiological data on simple hepatic cysts are limited and often derived from hospital-based studies, which may overestimate prevalence due to selection bias. Prior reports indicate widely varying prevalence rates (2.5%–18.0%), but these estimates are predominantly based on incidental findings from imaging studies conducted in clinical settings. Population-based studies are essential to establish accurate prevalence rates and identify factors associated with the development of hepatic cysts. This study addresses these gaps through a large-scale, community-based investigation in Shanghai, China, to determine the prevalence, anatomical characteristics, and independent risk factors for simple hepatic cysts.

Methods

Study Design and Population

This cross-sectional study enrolled 4,120 adults from 242 community health centers across 18 districts in Shanghai. Eligibility criteria included individuals aged 16–65 years residing in their communities for over six months, excluding those with serious chronic diseases, pregnancy, fractures, mental disorders, infectious diseases (e.g., hepatitis B/C, tuberculosis), or reduced mobility. After excluding 40 participants with incomplete ultrasound data and 15 individuals over 65 years of age, the final cohort comprised 4,065 adults.

Data Collection and Measurements

Participants underwent structured interviews, anthropometric measurements (e.g., weight, height), and blood sample collection. Ultrasound examinations of the abdomen were performed by blinded, experienced clinicians to diagnose hepatic cysts. Cysts were characterized by their number (single/multiple), size, and location within the liver. Biochemical parameters, including lipid profiles, glucose, and reproductive hormones (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]), were analyzed.

Statistical Analysis

Univariate and multivariate logistic regression models identified variables associated with hepatic cysts. Subgroup analyses were stratified by age and sex. Receiver operating characteristic (ROC) curves determined optimal thresholds for FSH and LH in premenopausal women. Trends in age-specific prevalence were assessed using the Cochran-Armitage test. Statistical significance was set at P < 0.05.

Results

Prevalence and Demographic Characteristics

Among 4,065 participants, 312 (7.68%) were diagnosed with simple hepatic cysts. The mean age of cyst-positive individuals was significantly higher than cyst-negative individuals (50.52 ± 9.58 vs. 41.41 ± 12.12 years; P < 0.0001). Males exhibited a slightly higher prevalence than females (8.34% vs. 7.16%; P = 0.157). Prevalence increased linearly with age across both sexes (P < 0.0001 for trend). Among cyst-positive individuals, 73.08% had a single cyst, while 26.92% had multiple cysts. The right anterior segment was the most common cyst location (30.68%).

Associations with Clinical and Biochemical Factors

In univariate analysis, age, hypertension, smoking, long-term medication use, and elevated body mass index (BMI) correlated with hepatic cysts (P < 0.05). However, multivariate analysis identified age as the sole independent risk factor (odds ratio [OR] = 5.135; 95% confidence interval [CI]: 3.515–7.504; P < 0.0001). Notably, premenopausal women (<45 years) with hepatic cysts exhibited significantly higher FSH and LH levels compared to controls (FSH: 10.30 vs. 6.94 IU/L, P = 0.001; LH: 9.74 vs. 6.71 IU/L, P = 0.002). ROC curves for this subgroup identified an FSH cutoff of 9.15 IU/L (sensitivity: 61.4%; specificity: 68.9%) and an LH cutoff of 8.25 IU/L (sensitivity: 56.6%; specificity: 72.7%) as predictive thresholds.

Subgroup Analyses

  1. Males <45 Years: Age (OR = 2.164; 95% CI: 1.080–4.333) and gallstones (OR = 3.168; 95% CI: 1.001–10.028) were independently associated with hepatic cysts.
  2. Premenopausal Women (<45 Years): Both age (OR = 2.096; 95% CI: 1.021–4.303) and elevated FSH (OR = 2.122; 95% CI: 1.082–4.160) predicted cyst presence.
  3. Older Adults (≥45 Years): No significant associations emerged for either sex, suggesting age-related physiological changes may overshadow other factors.

Discussion

Age as a Dominant Risk Factor

This study confirms age as the strongest predictor of simple hepatic cysts, aligning with prior hypotheses that cyst development reflects cumulative exposure to environmental or hormonal changes over time. The linear increase in prevalence with age underscores the importance of surveillance in older populations.

Reproductive Hormones in Premenopausal Women

The association between elevated FSH/LH and hepatic cysts in premenopausal women is novel. While FSH and LH receptors are not typically expressed in hepatic tissue, hormonal fluctuations during the menstrual cycle or subclinical ovarian dysfunction may indirectly influence cyst formation through systemic inflammatory or growth-promoting pathways. Further mechanistic studies are warranted to explore this relationship.

Gallstones and Hepatic Cysts in Younger Males

The link between gallstones and hepatic cysts in younger males suggests shared etiological pathways, such as biliary stasis or metabolic dysregulation. Gallstones may promote local inflammation or ductal obstruction, creating a microenvironment conducive to cyst development.

Methodological Strengths and Limitations

As the first population-based study in a socioeconomically diverse urban population, this investigation minimizes selection bias inherent in hospital-based cohorts. However, the cross-sectional design precludes causal inference, and the exclusion of individuals with chronic diseases may limit generalizability.

Conclusions

This study provides robust epidemiological data on simple hepatic cysts, emphasizing age as a critical risk factor and highlighting potential roles for reproductive hormones and gallstones in specific subgroups. These findings advocate for targeted screening in older adults and further research into hormonal and metabolic pathways influencing cystogenesis.

DOI: 10.1097/CM9.0000000000001361 (Available at doi.org/10.1097/CM9.0000000000001361)

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