Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: A multicenter matched analysis with HCV-related HCC

• Published in: Journal of hepatology 2015-07, Vol.63 (1), p.93-101
• Main Authors: Viganò, Luca, Conci, Simone, Cescon, Matteo, Fava, Cristina, Capelli, Paola, D’Errico, Antonietta, Torzilli, Guido, Di Tommaso, Luca, Giuliante, Felice, Vecchio, Fabio Maria, Salizzoni, Mauro, David, Ezio, Pinna, Antonio Daniele, Guglielmi, Alfredo, Capussotti, Lorenzo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - virology; Cirrhosis; Female; Follow-Up Studies; Gastroenterology and Hepatology; HCV-related HCC; Hepatectomy - methods; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - virology; Hepatocellular carcinoma; Humans; Liver failure; Liver Neoplasms - complications; Liver Neoplasms - surgery; Liver Neoplasms - virology; Liver surgery; Male; Metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - etiology; Middle Aged; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Obesity; Retrospective Studies; Steatosis; Survival; Treatment Outcome
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2015.01.024

Background & Aims The incidence of metabolic syndrome-related hepatocellular carcinoma (MS-HCC) is increasing worldwide. High resection risks are anticipated because of underlying steatohepatitis, but long-term results are unknown. To clarify the outcomes following liver resection in patients with MS-HCC and to compare the outcomes of MS-HCC to HCV-related HCC (HCV-HCC). Methods All the consecutive patients undergoing liver resection for HCC in six high-volume HPB units between 2000 and 2012 were retrospectively considered. The patients with MS-HCC were identified and matched one-to-one with HCV-HCC patients without metabolic syndrome. Matching was based on age, cirrhosis, Child-Pugh class, portal hypertension, HCC number and diameter and liver resection extension. Results Among 1563 patients undergoing liver resection for HCC in the study period, 96 (6.1%) had MS-HCC. They were matched with 96 HCV-HCC patients. All patients were Child-Pugh class A, 22.9% had cirrhosis. Forty-one patients per group (42.7%) required major hepatectomy. The MS-HCC group had a higher prevalence of steatohepatitis (25.0% vs. 9.4%, p = 0.004). Operative mortality was 2.1% (1 MS-HCC, 3 HCV-HCC, p = 0.621). Morbidity and liver failure rates were similar between the two groups. In the multivariate analysis, cirrhosis, major hepatectomy, and MELD >8, but not steatohepatitis, impacted severe morbidity and liver failure rates. The MS-HCC group had better 5-year overall survival (65.6% vs. 61.4%, p = 0.031) and recurrence-free survival (37.0% vs. 27.5%, p = 0.077). Independent negative prognostic factors were HCV-HCC, multiple HCC, microvascular invasion, and satellite nodules. Conclusions Liver resection is safe for MS-HCC, as for HCV-HCC. Cirrhosis, but not steatohepatitis, affects short-term outcomes. MS-HCC is associated with excellent long-term outcomes, better than HCV-HCC.