Is metabolic dysfunction-associated fatty liver disease a protective factor in hepatocellular carcinoma patients after hepatectomy? A retrospective study based on different analysis methods

Abstract

Background Metabolic dysfunction-associated fatty liver disease (MAFLD) has been recognized as an accurate reflection of the pathogenesis of fatty liver disease by a consensus document. However, the relationship between MAFLD and the prognosis of patients with hepatocellular carcinoma (HCC) remains unclear. Therefore, the main purpose of this study was to investigate the impact of MAFLD on the prognosis of HCC patients after hepatectomy. Methods To identify risk factors associated with poor prognosis, we used a multivariate Cox proportional hazards model. We also conducted propensity score matching (PSM) analysis to balance the baseline characteristics between the MAFLD and non-MAFLD groups. Kaplan‒Meier survival curves were used to compare the prognosis of the two matched groups. Results This study involved 909 HCC patients who underwent hepatectomy between January 2011 and December 2017 at the West China Hospital of Sichuan University, including 97 patients with MAFLD (MAFLD group) and 812 patients without MAFLD (non-MAFLD group). Our multivariate analysis results indicated that MAFLD might be a protective factor for overall survival (OS) (p = 0.032), but not for recurrence-free survival (RFS) (p = 0.214). After conducting PSM analysis, we found that the RFS rates in the MAFLD group were higher at the 1-, 3-, and 5-year intervals, with rates of 72.7%, 59.0%, and 49.9%, respectively, than those in the non-MAFLD group, which had rates of 69.8%, 54.3%, and 43.2%, respectively. Therefore, MAFLD might improve the 1-year, 3-year, and 5-year RFS rates of HCC patients who undergo hepatectomy. In the subgroup analysis, we found that patients in the overweight group had better RFS than those in the lean/normal group (p＜0.001). Conclusions In summary, our study suggests that MAFLD might be a protective factor for the OS of HCC patients who underwent hepatectomy through multivariate analysis. Furthermore, after PSM analysis, MAFLD was found to improve the 1-year, 3-year, and 5-year RFS rates of HCC patients who underwent hepatectomy, especially those who were overweight. These findings may have implications for the management and treatment of HCC patients with MAFLD.