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

Abstract

Background Whether the safety and efficacy of hepatic resection differ between patients whose hepatocellular carcinoma (HCC) is related to non-alcoholic fatty liver disease (NAFLD) or has other aetiologies is unknown. A systematic review was performed to explore potential differences between such conditions. Methods PubMed, EMBASE, Web of Science, and Cochrane Library were systematically searched for relevant studies that reported hazard ratios (HRs) for overall and recurrence-free survival between patients with NAFLD-related HCC or HCC of other aetiologies. Results The meta-analysis involved 17 retrospective studies involving 2470 patients (21.5 per cent) with NAFLD-related HCC and 9007 (78.5 per cent) with HCC of other aetiologies. Patients with NAFLD-related HCC were older and had higher body mass index (BMI), but were less likely to have cirrhosis (50.4 per cent versus 64.0 per cent, P < 0.001). The two groups suffered similar rates of perioperative complications and mortality. Patients with NAFLD-related HCC had slightly higher overall survival (HR 0.87, 95 per cent c.i. 0.75 to 1.02) and recurrence-free survival (HR 0.93, 95 per cent c.i. 0.84 to 1.02) than those with HCC of other aetiologies. In the various subgroup analyses, the only significant finding was that Asian patients with NAFLD-related HCC had significantly better overall survival (HR 0.82, 95 per cent c.i. 0.71 to 0.95) and recurrence-free survival (HR 0.88, 95 per cent c.i. 0.79 to 0.98) than Asian patients with HCC of other aetiologies. Conclusion The available evidence suggests that patients with NAFLD-related HCC have similar perioperative complications and mortality, but potentially longer overall and recurrence-free survival, compared with those with HCC of other aetiologies. Tailored surveillance strategies should be developed for patients with NAFLD without cirrhosis.

Proportion of metabolic syndrome in hepatocellular carcinoma patients with different etiologies: a retrospective study

“…22 If their HCC is related to MAFLD, patients may have better survival and show major perioperative complications compared with patients with HCC of other aetiologies. 23 This study reveals that patients diagnosed with MAFLD-related HCC commonly exhibit preoperative comorbidities, including MetS and cardiac or kidney comorbidities, but CHB-related HCC tends to present a more severe liver disease. HCV-positive patients may exhibit both severe MetS and a more severe liver disease.…”

The Influence of Hepatic Steatosis and Fibrosis on Postoperative Outcomes After Major Liver Resection of Perihilar Cholangiocarcinoma

“…In a recent meta-analysis, cirrhosis was present in at least half of all the patients who underwent hepatic resection for HCC. 32 In contrast to intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma is less frequently reported for patients with a background of liver cirrhosis. 33 In two large population studies, liver cirrhosis was found in 8–10% of iCCA patients compared with 4% of 539 patients who underwent a resection for pCCA.…”

Adjuvant Therapy for Hepatocellular Carcinoma After Curative Treatment: Several Unanswered Questions

“… 20 – 22 HCC patients usually have underlying chronic liver disease or cirrhosis caused by chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, alcoholic, or nonalcoholic steatohepatitis. 23 They thus always have early and late phase recurrence risk factors.…”