Simone Conci1, Federica Cipriani2, Matteo Donadon3, Ivan Marchitelli1, Francesco Ardito4, Simone Famularo5, Pasquale Perri6, Maurizio Iaria7, Luca Ansaloni8, Matteo Zanello9, Giuliano La Barba10, Stefan Patauner11, Enrico Pinotti12, Sarah Molfino13, Paola Germani14, Maurizio Romano15, Ivano Sciannamea16, Cecilia Ferrari17, Alberto Manzoni18, Albert Troci19, Luca Fumagalli20, Antonella Delvecchio21, Antonio Floridi22, Riccardo Memeo21, Marco Chiarelli20, Michele Crespi19, Giuseppe Zimmitti18, Guido Griseri17, Adelmo Antonucci16, Giacomo Zanus15, Paola Tarchi14, Gian Luca Baiocchi13, Mauro Zago23, Antonio Frena11, Giorgio Ercolani24, Elio Jovine9, Marcello Maestri8, Raffaele Dalla Valle7, Gian Luca Grazi6, Fabrizio Romano25, Felice Giuliante4, Guido Torzilli3, Luca Aldrighetti26, Andrea Ruzzenente27. 1. Division of General and Hepatobiliary Surgery, Department of Surgery, University of Verona, G.B. Rossi University Hospital, Verona, Italy. 2. Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy. 4. Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy. 5. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital Monza, Italy. 6. Division of Hepatobiliary Pancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy. 7. HPB Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy. 8. Unit of General Surgery 1, Foundation IRCCS Policlinico San Matteo, Pavia, Italy. 9. Department of Surgery, Alma Mater Studiorum, IRCCS Azienda ospedaliera universitaria Sant'Orsola di Bologna, Bologna, Italy. 10. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy. 11. Department of Surgery, Bolzano Central Hospital, Bolzano, Italy. 12. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy. 13. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 14. Surgical Clinic, University Hospital of Trieste, Trieste, Italy. 15. Hepatobiliary Pancreatic Division, Department of Surgical, Oncological and Gastroenterological Science, Treviso Hospital, Padua University Italy, Padua, Italy. 16. Department of Surgery, Monza Policlinic, Monza, Italy. 17. HPB Surgical Unit, San Paolo Hospital, Savona, Italy. 18. Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy. 19. Department of Surgery, L. Sacco Hospital, Milan, Italy. 20. Department of Surgery, ASST Lecco, Lecco, Italy. 21. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy. 22. Department of General Surgery, ASST Crema, Crema, Italy. 23. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy; Department of Surgery, ASST Lecco, Lecco, Italy. 24. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 25. School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital Monza, Italy. 26. Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 27. Division of General and Hepatobiliary Surgery, Department of Surgery, University of Verona, G.B. Rossi University Hospital, Verona, Italy. Electronic address: andrea.ruzzenente@univr.it.
Abstract
BACKGROUND AND AIMS: We investigated the clinical impact of the newly defined metabolic-associated fatty liver disease (MAFLD) in patients undergoing hepatectomy for HCC (MAFLD-HCC) comparing the characteristics and outcomes of patients with MAFLD-HCC to viral- and alcoholic-related HCC (HCV-HCC, HBV-HCC, A-HCC). METHODS: A retrospective analysis of patients included in the He.RC.O.Le.S. Group registry was performed. The characteristics, short- and long-term outcomes of 1315 patients included were compared according to the study group before and after an exact propensity score match (PSM). RESULTS: Among the whole study population, 264 (20.1%) had MAFLD-HCC, 205 (15.6%) had HBV-HCC, 671 (51.0%) had HCV-HCC and 175 (13.3%) had A-HCC. MAFLD-HCC patients had higher BMI (p < 0.001), Charlson Comorbidities Index (p < 0.001), size of tumour (p < 0.001), and presence of cirrhosis (p < 0.001). After PSM, the 90-day mortality and severe morbidity rates were 5.9% and 7.1% in MAFLD-HCC, 2.3% and 7.1% in HBV-HCC, 3.5% and 11.7% in HCV-HCC, and 1.2% and 8.2% in A-HCC (p = 0.061 and p = 0.447, respectively). The 5-year OS and RFS rates were 54.4% and 37.1% in MAFLD-HCC, 64.9% and 32.2% in HBV-HCC, 53.4% and 24.7% in HCV-HCC and 62.0% and 37.8% in A-HCC (p = 0.345 and p = 0.389, respectively). Cirrhosis, multiple tumours, size and satellitosis seems to be the independent predictors of OS. CONCLUSION: Hepatectomy for MAFLD-HCC seems to have a higher but acceptable operative risk. However, long-term outcomes seems to be related to clinical and pathological factors rather than aetiological risk factors.
BACKGROUND AND AIMS: We investigated the clinical impact of the newly defined metabolic-associated fatty liver disease (MAFLD) in patients undergoing hepatectomy for HCC (MAFLD-HCC) comparing the characteristics and outcomes of patients with MAFLD-HCC to viral- and alcoholic-related HCC (HCV-HCC, HBV-HCC, A-HCC). METHODS: A retrospective analysis of patients included in the He.RC.O.Le.S. Group registry was performed. The characteristics, short- and long-term outcomes of 1315 patients included were compared according to the study group before and after an exact propensity score match (PSM). RESULTS: Among the whole study population, 264 (20.1%) had MAFLD-HCC, 205 (15.6%) had HBV-HCC, 671 (51.0%) had HCV-HCC and 175 (13.3%) had A-HCC. MAFLD-HCC patients had higher BMI (p < 0.001), Charlson Comorbidities Index (p < 0.001), size of tumour (p < 0.001), and presence of cirrhosis (p < 0.001). After PSM, the 90-day mortality and severe morbidity rates were 5.9% and 7.1% in MAFLD-HCC, 2.3% and 7.1% in HBV-HCC, 3.5% and 11.7% in HCV-HCC, and 1.2% and 8.2% in A-HCC (p = 0.061 and p = 0.447, respectively). The 5-year OS and RFS rates were 54.4% and 37.1% in MAFLD-HCC, 64.9% and 32.2% in HBV-HCC, 53.4% and 24.7% in HCV-HCC and 62.0% and 37.8% in A-HCC (p = 0.345 and p = 0.389, respectively). Cirrhosis, multiple tumours, size and satellitosis seems to be the independent predictors of OS. CONCLUSION: Hepatectomy for MAFLD-HCC seems to have a higher but acceptable operative risk. However, long-term outcomes seems to be related to clinical and pathological factors rather than aetiological risk factors.
Authors: Anastasia Murtha-Lemekhova; Juri Fuchs; Svenja Feiler; Erik Schulz; Miriam Teroerde; Eva Kalkum; Rosa Klotz; Adrian Billeter; Pascal Probst; Katrin Hoffmann Journal: BMC Med Date: 2022-01-28 Impact factor: 8.775