The Effect of Metabolic Syndrome on the Outcome of Hepatitis B-Associated Hepatocellular Carcinoma Patients After Hepatectomy: A Multicenter Study

Abstract

Background and AimsWith changes in dietary patterns and modern lifestyles, the prevalence of metabolic syndrome (MetS) in hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) patients is increasing. The purpose of our study is to explore the impact of MetS on the prognosis of HBV-associated HCC patients following radical hepatectomy.MethodsData on consecutive HCC patients who underwent radical hepatectomy were prospectively obtained and retrospectively analyzed from seven medical centers in west areas of China. Propensity score matching (PSM) analysis was conducted to balance the heterogeneity between MetS-HBV-HCC group and HBV-HCC group. Surgical outcomes have been contrasted between the two groups.ResultsIn 984 patients, 179 (18.19%) were diagnosed with MetS. Patients in the MetS-HBV-HCC group had higher CCI score (8.7 [0.0, 12.2] vs. 0.0 [0.0, 8.7], p = 0.048) and a higher rate of severe complications (Clavien–Dindo ≥3, 7.82% vs. 4.10%, p = 0.035), to be more precise: postoperative liver failure, hydrothorax, and hyperglycemia. Patients in the MetS-HBV-HCC group tended to have worse 5-year overall survival (OS) rate (61.45% vs. 69.94%, p = 0.027) and recurrence-free survival (RFS) rate (62.57% vs. 53.66%, p = 0.030), consistent with the results of the competing risk models. Last, MetS was identified to be an independent unfavorable prognostic factor in the multivariate analysis.ConclusionThe involvement of MetS increased the risk of postoperative complications and worsens the overall survival and recurrence-free survival time, reminding us to be more prudent to face metabolic disorder among tumor patients.

Metabolic syndrome and survival of patients with hepatocellular carcinoma: A meta-analysis

“…However, for patients with diagnosed HCC, the influence of MetS on their survival remains unclear (18). Some previous studies showed that MetS may be a risk factor of poor survival of patients with HCC (19)(20)(21)(22)(23), while other studies did not show similar results (24)(25)(26)(27)(28). In this study, we performed a systematic review and metaanalysis to comprehensively investigate the association between MetS and survival of patients with HCC.…”

“…In addition, 1071 articles were excluded since their titles and abstracts were not relevant to the meta-analysis, leaving 26 studies in total for the full-text review. Finally, after excluding 16 studies through full-text review, ten studies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) were included. The reasons for the removing of the 16 studies are also presented in Figure 1.…”

“…As shown in Table 1, ten cohort studies, eight retrospective studies (19)(20)(21)(22)(23)(24)(25)27) and two prospective studies (26,28), involving 8080 patients with HCC were included in the meta-analysis. These studies were published between 2015 and 2022, and performed Italy, Japan, Germany, China, and the United States.…”

“…The mean ages of the patients were 50.6 to 70.2 years. The National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria were used for the diagnosis of MetS in seven studies (19,(21)(22)(23)(24)(25)(26), while the International Diabetes Federal (IDF) criteria were used in the other three studies (20,27,28). Accordingly, 1166 patients (14.4%) had MetS at baseline.…”

“…The mean follow-up durations varied between 2.2 and 5.0 years. The outcome of OS was reported in all of the included ten studies (19)(20)(21)(22)(23)(24)(25)(26)(27)(28), while the outcome of PFS was reported in seven studies (19)(20)(21)(22)(23)(24)27). Multivariate models were applied to analyze the association between MetS and survival outcomes in HCC, and possible confounding factors such as age, sex, hepatic function, tumor size, grade, and treatments etc.…”