The impact of metabolic syndrome (MetS) on surgical outcome for patients with mostly HBV‐related hepatocellular carcinoma (HCC) underwent hepatectomy

Tian, Yunhong; Li, Tie; Qi, Shouliang; Alhourani, Hani; Luo, Binyu; Chenqin, Junjie; Fu, Qizhong; Peng, Yong; Wu, Jianlin

doi:10.1002/jso.26055

Cited by 7 publications

(15 citation statements)

References 28 publications

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“…Previous studies have reported that hepatectomy for patients with MS is safe, feasible and beneficial to prognosis, although the probability of postoperative complications is higher (6,8,10,35,36). Similarly, the incidence of postoperative complications was also high among HBV-infected HCC patients with MS in our cohort, although there was no difference between the two groups (52.1% vs. 49.8%, P= 0.772).…”

Section: Discussionmentioning

confidence: 99%

“…Metabolic syndrome (MS) is a clinical syndrome of obesity, dyslipidemia (low high-density lipoproteinemia and/or high triglyceridemia), hyperglycemia (diabetes or impaired glucose regulation), and hypertension (4,5). Previous studies have shown that hepatectomy for MS-HCC has a higher but acceptable operative risk, but the long-term survival outcome remains controversial (6)(7)(8)(9)(10)(11). Reasons for the controversy include a small sample size or an uneven baseline of enrolled patients.…”

Section: Introductionmentioning

confidence: 99%

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Impact of metabolic syndrome on the long-term prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after hepatectomy

Zhang

Ye²,

Lu³

et al. 2022

Front. Oncol.

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Background & aimsThe long-term prognosis of patients with metabolic syndrome (MS) and hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) after radical hepatectomy remains unclear. The purpose of this study was to elucidate the effect of MS on long-term survival for patients with HBV-related HCC after hepatectomy.MethodsPatients with HBV-HCC after hepatectomy were included. Patients were stratified into MS-HBV-HCC and HBV-HCC groups. Clinical features and surgical outcomes were compared between the two groups, and COX regression analysis was used to determine independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS).Result389 patients (MS-HBV-HCC group: n=50, HBV-HCC group: n=339) were enrolled for further analysis. Baseline characteristics showed that patients with MS-HBV-HCC were associated with a high rate of elderly patients, ASA score, and co-morbid illness, but a lower rate of anatomy hepatectomy. There were no significant differences in perioperative complications. After excluding patients who relapsed or died within 90 days after surgery, multivariate Cox regression analysis showed MS was an independent risk factor of OS (HR 1.68, 95% CI 1.05-2.70, P = 0.032) and RFS (HR 1.78, 95% CI 1.24-2.57, P = 0.002).ConclusionMS is an independent risk factor for poor OS and RFS in HBV-infected HCC patients after radical hepatectomy. This suggests that we need to strengthen postoperative follow-up of the relevant population and encourage patients to develop a healthy lifestyle.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of metabolic syndrome on the long-term prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after hepatectomy

Zhang

Ye²,

Lu³

et al. 2022

Front. Oncol.

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“…Overall complications were assessed based on data from eleven studies [ 17 , 19 , 21 – 23 , 25 – 29 , 31 ]. Data on major and minor complications was available in eight [ 17 , 19 , 22 , 25 – 28 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

Is metabolic syndrome a risk factor in hepatectomy? A meta-analysis with subgroup analysis for histologically confirmed hepatic manifestations

Murtha-Lemekhova

Fuchs

Feiler

et al. 2022

BMC Med

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Background Metabolic syndrome (MetS) is a risk factor in surgery. MetS can progress to metabolic (dysfunction)-associated fatty liver disease (MAFLD), a vast-growing etiology of primary liver tumors which are major indications for liver surgery. The aim of this meta-analysis was to investigate the impact of MetS on complications and long-term outcomes after hepatectomy. Methods The protocol for this meta-analysis was registered at PROSPERO prior to data extraction. MEDLINE, Web of Science, and Cochrane Library were searched for publications on liver resections and MetS. Comparative studies were included. Outcomes encompassed postoperative complications, mortality, and long-term oncologic status. Data were pooled as odds ratio (OR) with a random-effects model. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS), and the certainty of the evidence was evaluated with GRADE. Subgroup analyses for patients with histopathologically confirmed non-alcoholic fatty liver disease (NAFLD) versus controls were performed. Results The meta-analyses included fifteen comparative studies. Patients with MetS suffered significantly more overall complications (OR 1.55; 95% CI [1.05; 2.29]; p=0.03), major complications (OR 1.97 95% CI [1.13; 3.43]; p=0.02; I2=62%), postoperative hemorrhages (OR 1.76; 95% CI [1.23; 2.50]; p=0.01) and infections (OR 1.63; 95% CI [1.03; 2.57]; p=0.04). There were no significant differences in mortality, recurrence, 1- or 5-year overall or recurrence-free survivals. Patients with histologically confirmed NAFLD did not have significantly more overall complications; however, PHLF rates were increased (OR 4.87; 95% CI [1.22; 19.47]; p=0.04). Recurrence and survival outcomes did not differ significantly. The certainty of the evidence for each outcome ranged from low to very low. Conclusion Patients with MetS that undergo liver surgery suffer more complications, such as postoperative hemorrhage and infection but not liver-specific complications—PHLF and biliary leakage. Histologically confirmed NAFLD is associated with significantly higher PHLF rates, yet, survivals of these patients are similar to patients without the MetS. Further studies should focus on identifying the tipping point for increased risk in patients with MetS-associated liver disease, as well as reliable markers of MAFLD stages and early markers of PHLF. Trial registration PROSPERO Nr: CRD42021253768

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“…Specific genetic contributions may help explain differences observed in PAFs for HCC between race/ethnic groups. 29 While insulin resistance likely plays a role in its pathogenesis, oxidative injury and inflammatory reactions could be influenced by genetics. A study performed in the US among Hispanic, NH black and NH white individuals identified the variant, rs73809, (148M) in patatinlike phospholipase domain-containing protein 3 (PNPLA3) as a predictor for hepatic fat content.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Hepatocellular Carcinoma in the United States: Differences in Risk Factor and Genetic Susceptibility by Race/Ethnicity

Rafique

Kristjansson

2021

Georgetown Scientific Research Journal

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Background: Hepatocellular carcinoma (HCC) is one of the few cancers with an increasing incidence and mortality worldwide. This study aims to determine the contribution of known risk factors for HCC by race and ethnicity. Methods: Data on race, ethnicity, age, and gender were obtained from National Health and Nutrition Examination Survey (NHANES). Population attributable fractions (PAFs) of risk factors were estimated using non-invasive scoring measures of Hepatitis B and C virus infection, excessive alcohol use, smoking, diabetes and emerging metabolic risk factors [non-alcoholic steatohepatitis advanced cirrhosis (NASH) and non-alcoholic fatty liver disease-advanced fibrosis (NAFLD-fib)] over a 10-year period, 1999-2002 and 2009-2012. Genetic analysis was performed using DisGenet platform by attaining the top enriched genes strongly related to HCC. Furthermore, cytoscape network was used to form a gene-disease network association. Results: NASH-cirrhosis increased in the overall population and among all race and ethnic groups. Both liver fat accumulation and ALT levels vary among different populations; however, Hispanics have the highest prevalence of NAFLD and elevated ALT levels. Non-Hispanic (NH) blacks and Hispanics had a 3 to 4 times higher PAF for HCC than whites attributed due to chronic liver diseases, including NASH-cirrhosis and NAFLD-fib. Our genetic analysis demonstrated that PNPLA3 polymorphism is strongly associated with NAFLD-fib, which appears to represent susceptibility to liver disease among the Hispanic community. Conclusion: Hispanics and NH blacks are at a disproportionately higher risk for HCC in part due to the higher prevalence of liver disease comorbidities, including NASH-cirrhosis and NAFLD-fib. Compared to NH whites, Hispanics and NH blacks have a higher baseline risk for liver cancer due to non-metabolic factors, which may include a genetic susceptibility. Metabolic risk factors have increased and are now contributing to nearly half of HCC cases in the US.

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The impact of metabolic syndrome (MetS) on surgical outcome for patients with mostly HBV‐related hepatocellular carcinoma (HCC) underwent hepatectomy

Cited by 7 publications

References 28 publications

Impact of metabolic syndrome on the long-term prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after hepatectomy

Impact of metabolic syndrome on the long-term prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after hepatectomy

Is metabolic syndrome a risk factor in hepatectomy? A meta-analysis with subgroup analysis for histologically confirmed hepatic manifestations

Determinants of Hepatocellular Carcinoma in the United States: Differences in Risk Factor and Genetic Susceptibility by Race/Ethnicity

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