Outcomes of Liver Resection for Metabolic Dysfunction-Associated Fatty Liver Disease or Chronic Hepatitis B-Related HCC

Abstract

AimsThis study aims to determine differences in severity of background liver disease at hepatocellular carcinoma (HCC) diagnosis and long-term survival outcomes among patients undergoing liver resection for HCC in the background of metabolic dysfunction-associated fatty liver disease (MAFLD) compared to chronic hepatitis B (CHB) alone or concurrent CHB (CHB/MAFLD).MethodsPatient demographics and comorbidities, clinicopathologic data, perioperative and long-term outcomes among patients who underwent liver resection for HCC were reviewed. Overall and recurrence-free survival were calculated with the Kaplan-Meier method, with the values compared using the log-rank test.ResultsFrom January 2014 to December 2018, 1325 patients underwent potential curative liver resection of HCC; 67 (5.0%), 176 (13.3%), and 1082 (81.7%) patients had MAFLD alone, CHB concurrent with MAFLD, and CHB alone, respectively. At HCC diagnosis, fewer MAFLD patients had cirrhosis, alpha fetoprotein concentration ≥ 400 ng/mL, tumor size ≥ 5 cm, mulinodular, microvascular invasion, receiving major hepatectomy, and receiving adjuvant transarterial chemoembolization. After a median follow-up of 47 months after liver resection, MAFLD (or MAFLD plus CHB/MAFLD) patients had significantly higher overall and recurrence-free survival than CHB patients before or after propensity score analysis (all P<0.05).ConclusionPatients with HCC in the setting of MAFLD have less-severe background liver disease at HCC diagnosis and better long-term survival after curative liver resection compared to counterparts with CHB/MAFLD or CHB.

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

“…Eight studies reported the incidence of perioperative complications, which was higher in the observation group than in the control group in four studies 49 , 54 , 56 , 59 , lower in the observation group in two studies 19 , 57 , and similar between the observation and control groups in the other two studies 20 , 21 . Pooling the patients across all eight studies showed that the rate of major complications was similar between the observation group (8.98 per cent, 93/1035) and control group (9.0 per cent, 466/5153; P = 1.000).…”

“…S1 ). Compared with patients with HCC of other aetiologies, those with NAFLD-related HCC had a higher BMI, they were older in 11 studies 19 , 21 , 49–52 , 54–57 , 59 , and they showed significantly lower cirrhosis rates in 11 studies 19–22 , 48 , 49 , 51 , 53–55 , 57 of the 15 that reported cirrhosis rates 19–22 , 48 , 49 , 51 , 53–60 . When cirrhosis rates were calculated across all patients pooled from the studies, prevalence was significantly lower in the observation group than in the control group ( P < 0.001).…”

“…The studies covered 28 years (1991–2019). Of the 17 studies, 10 applied standard definitions of NAFLD 21 , 48–51 , 54 , 55 , 57–59 , 4 applied standard definitions of MAFLD 19 , 20 , 22 , 60 , 2 applied standard definitions of steatosis 53 , 56 , and 1 applied a standard definition of NASH 52 . Patients in all studies except one underwent hepatectomy; those in the study applying a standard definition of NASH 52 underwent liver transplantation, hepatectomy, and radiofrequency ablation, all of which are radical treatments.…”

“…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 .…”

Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: Current Progresses and Challenges

“… 79 – 82 Several recent retrospective studies have compared outcomes after hepatic resection to treat NAFLD-related HCC or HCC of other etiologies. Some studies suggested that patients with NAFLD-related HCC had longer survival, 83 , 84 while others found similar overall survival among patients with HCC of different etiologies. 85 , 86 Two recently published meta-analyses concluded that patients with NAFLD-related HCC had better overall and disease-free survival after hepatic resection than patients with HCC of other etiologies.…”