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Liver resection safe for metabolic syndrome- and HCV-related HCC

Liver resection was safe among patients with metabolic syndrome- and hepatitis C virus-related hepatocellular carcinoma, with only cirrhosis associated with worse short-term outcomes, according to study data.

Researchers analyzed data of 1,563 patients who underwent liver resection for HCC in six centers between 2000 and 2012. The patients with metabolic syndrome-related HCC (MS-HCC) were matched with patients with HCV-related HCC without metabolic syndrome (HCV-HCC) based on age, cirrhosis, liver resection number and other variables.

Overall, 6.1% of all the patients analyzed had MS-HCC (n = 96) and were matched with 96 HCV-HCC patients. All of the patients were Child-Pugh class A and 23% had cirrhosis.

“The outcome of liver surgery in MS-HCC has been poorly evaluated. Some series analyzed outcomes of surgery in obese patients, diabetics or in the presence of nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, but only one paper focused on MS-HCC, reporting good mid-term results, but high operative risks,” the researchers wrote. “The aims of the present study were … to elucidate the short and long-term outcomes of liver surgery in a large series of MS-HCC patients [and] to compare the outcome of MS-HCC to HCV-HCC.”

Analyses showed that patients in the MS-HCC group had a higher prevalence of steatohepatitis compared with HCV-HCC patients (25% vs. 9.4%; P = .004).

Patients in the MS-HCC group yielded a better 5-year overall survival rate compared with patients in the HCV-HCC group (65.6% vs. 61.4%; P = .031). In addition, the MS-HCC group had higher recurrence-free survival compared with the HCV-HCC group (37% vs. 27.5%; P = .077).

According to multivariate analysis, independent predictors of severe morbidity and liver failure included major hepatectomy (P = .011, P = .009), liver cirrhosis (P = .005, P = .0002) and a MELD score greater than 8 (P = .015, P = .015), respectively. Morbidity and liver failure rates were similar between the two groups.

“Steatosis, NASH and metabolic disorders had no impact on short-term outcomes, even when considering major hepatectomies,” the researchers wrote.

In the MS-HCC group only, liver cirrhosis was the only independent factor of postoperative liver failure (P = .047). Independent negative prognostic factors were HCV-HCC, multiple HCC, microvascular invasion and satellite nodules, according to the research.

“In selected patients, [liver resection] for MS-HCC has low mortality, but high morbidity rates, similar to those of HCV-HCC,” the researchers concluded. “NAFLD and NASH are common in MS-HCC patients, but cirrhosis affects short-term outcomes, not NASH. MS-HCC has excellent long-term results, better than HCV-HCC.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.