Hepatic Resection for Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Abstract

Structured summary2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number. INTRODUCTIONRationale 3 Describe the rationale for the review in the context of what is already known.Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS). METHODS Protocol and registration5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis). Data collection process10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators. Data items11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.9 Risk of bias in individual studies12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis. 9-10Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 11Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I 2 ) for each meta-analysis. 11Section/topic # Checklist item Reported on page # Risk of bias across studiesSpecify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies). 9-10Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified. 11 RESULTS Study selectionGive numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.

Prognosis after hepatic resection of patients with hepatocellular carcinoma related to non-alcoholic fatty liver disease: meta-analysis

“…The finding of similar OS and RFS between the two groups of patients contrasts with the significantly higher survival reported for patients with NAFLD- or MAFLD-related HCC in two previous meta-analyses involving 7226 17 and 5579 patients respectively 18 . The present results may be more reliable because the sample is substantially larger (11 477 patients) and the inclusion criteria are more stringent.…”

“…It is not clear whether these differences translate into a different prognosis after hepatic resection. Two meta-analyses have evaluated the safety and prognosis of hepatic resection for treating NAFLD-related HCC 17 , 18 , but they included relatively few original studies, and several relevant studies have been published since then 19–22 . Moreover, the meta-analyses were less rigorous in their inclusion criteria, such that some patients in the observation group did not meet diagnostic standards for NAFLD-related HCC 23–28 , and some patients received palliative treatment instead of resection 29–33 .…”

Association between Metabolic Disorders and Cholangiocarcinoma: Impact of a Postulated Risk Factor with Rising Incidence

“…Although the sample size was small, these findings generate the hypothesis that background etiology may impact the risk of recurrence and mortality after resection. Similar findings have been demonstrated in resected MAFLD-HCC in a recently published metanalysis [ 28 , 29 ]. In our case, a potential explanation is that patients tend to be more adherent to medical treatment and lifestyle changes after the diagnosis of CCA, and it would minimize the carcinogenic effect of overweight and altered glucose metabolism in the follow-up.…”

Clinical characteristics, surveillance, treatment allocation, and outcomes of non-alcoholic fatty liver disease-related hepatocellular carcinoma: a systematic review and meta-analysis

“…This outcome might be related to the higher proportion of patients with NAFLD-related hepatocellular carcinoma without cirrhosis, as cirrhosis increases the risk of hepato cellular carcinoma recurrence after resection. 46,47 Several studies have reported improved outcomes in NAFLD-related compared with non-NAFLD-related hepato cellular carcinoma, 48,49 although there have also been reports of more advanced disease at presen tation and poorer outcomes for NAFLD-related hepato cellular carcinoma. 14,50 These conflicting results could have arisen from previous studies being specific to a country, region, or treat ment, hence limiting their generalisability.…”