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Outcome of Liver Resection for Metabolic Syndrome Related HCC: a Comparative Study With Viral and Alcohol Related HCC
Andrea Ruzzenente*, Michela De Angelis, Simone Conci, Fabio Bagante, Alessandro Valdegamberi, Francesca Bertuzzo, Calogero Iacono, Alfredo Guglielmi
Department of Surgery - Division of General and Hepatobiliary Surgery, University of Verona Medical School, Verona, Italy
Background and aims: Up to 30% of HCC are associated with non-alcoholic fatty liver disease (NAFLD) that is hepatic manifestations of metabolic syndrome (MS).
The aims of the study were to analyse the clinical characteristics of MS associated HCC compared to alcoholic and viral HCC and to compare the short-term and long-term outcomes among groups.
Methods: 129 consecutive patients with available etiology data underwent liver resection for HCC from January 2006 to December 2013 in a single HPB tertiary referral center. The clinical and pathological features, treatment modalities, overall survival and disease-free survival data were analysed. According to aetiology the study population was classified in three groups: metabolic syndrome related HCC (MS-HCC), alcohol abuse related HCC (A-HCC), and viral infection related HCC (V-HCC).
Results: Among 129 patients with HCC, 26 patients (19.3%) had MS-HCC, 37 patients (27.4%) had A-HCC and 72 patients (53.3%) had V-HCC. Patients with MS-HCC resulted older compare with A-HCC and V-HCC with a mean age of 72.04, 68.65 and 65.04 years, respectively, p=0.018. MS-HCC showed lower rate of underlying cirrhosis (32% vs. 47.2% in A-HCC and 70.8% in V-HCC, respectively, p=0.001).
Postoperative mortality was higher in MS-HCC (7.7%) compared to A-HCC (2.7%) and V-HCC (0%) the difference was not statistically significant (p=0.072). Overall complications did not differ between groups, with a morbidity rate of 53.8%, 45.9% and 45.8% for MS-HCC, A-HCC and V-HCC, respectively (p= 0.765). Five-years overall survival rate of MS-HCC, A-HCC and V-HCC was 71.7%, 49.2% and 37.2% months, respectively (p = 0.701). Factors related with survival at univariate analysis were: number of nodules (p=0.047), vascular invasion (p<0.001), bilirubin (p=0.015), AST (p=0.005), albumin (p=0.004), platelets (p=0.001) and AFP (p=0.022). Multivariate analysis confirmed that vascular invasion (HR 2.901, p=0.004), bilirubin (HR 2.179, p= 0.052), albumin (HR 0.434, p=0.083) and platelets (HR 0.092, p=0.003) were independent factors related to survival. Five-years DFS rate was 54.7% in MS-HCC, 33.6% in A-HCC and 26.3% in V-HCC (MS-HCC vs. A-HCC, p=0.050; MS-HCC vs. V-HCC, p=0.044; A-HCC vs. V-HCC, p=0.753). Factors related with DFS at univariate analysis were: size >5cm (p=0.037), vascular invasion (p=0.041), number of nodules ≥2 (p=0.001), and cirrhosis (p=0.065). Multivariate analysis confirmed that size >5cm (p=0.008), vascular invasion (p=0.035), and cirrhosis (p=0.001) were independent factors related to DFS.
Conclusions: Patients in MS-HCC presented different clinical characteristics than A-HCC and V-HCC. Survival was not statistically different, while DFS was significantly higher in patients with MS-HCC compared to A-HCC and V-HCC, however DFS seem to be related mainly to cirrhosis and characteristics of tumour rather than HCC aetiology.
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