Luca Viganò1, Simone Conci2, Matteo Cescon3, Cristina Fava4, Paola Capelli5, Antonietta D'Errico6, Guido Torzilli7, Luca Di Tommaso8, Felice Giuliante9, Fabio Maria Vecchio10, Mauro Salizzoni11, Ezio David12, Antonio Daniele Pinna3, Alfredo Guglielmi2, Lorenzo Capussotti13. 1. Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy; Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy. Electronic address: luca.vigano@humanitas.it. 2. Department of Surgery, Unit of HPB Surgery, GB Rossi University Hospital, Verona, Italy. 3. Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy. 4. Department of Pathology, Ospedale Mauriziano Umberto I, Torino, Italy. 5. Department of Pathology, University Hospital, Verona, Italy. 6. Department of Pathology, S. Orsola Hospital, University of Bologna, Bologna, Italy. 7. Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy. 8. Department of Pathology, Humanitas Clinical and Research Center, Rozzano (MI), Italy. 9. Hepatobiliary Unit, Department of Surgery, Catholic University of the Sacred Heart, Roma, Italy. 10. Department of Pathology, Catholic University of the Sacred Heart, Roma, Italy. 11. Department of Surgery and Liver Transplantation, A.O. Città della Salute e della Scienza, Torino, Italy. 12. Department of Pathology, A.O. Città della Salute e della Scienza, Torino, Italy. 13. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy.
Abstract
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.
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.
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485