Liver Resection for Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: a Multicenter Propensity Matching Analysis with HBV-HCC
- 42 Downloads
The incidence of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. Higher perioperative risks may be anticipated due to underlying steatohepatitis, while long-term outcomes after liver resection are unknown. We sought to investigate outcomes after liver resection for NAFLD-HCC versus hepatitis B virus (HBV)-HCC using propensity score matching (PSM).
Consecutive patients who underwent liver resection for HCC between 2003 and 2014 were identified from a multicenter database. Patients with NAFLD-HCC were matched one-to-one to patients with HBV-HCC.
Among 1483 patients identified, 96 (6.5%) had NAFLD-HCC and 1387 (93.5%) had HBV-HCC. Patients with NAFLD-HCC were older (median age 57 vs. 50 years), more often overweight (50.0% vs. 37.5%), less often to have cirrhosis (30.2% vs. 72.5%) and liver dysfunction (Child-Pugh B: 4.2% vs. 10.7%), had larger tumor size (median 7.2 vs. 6.2 cm) yet had better tumor differentiation (27.1% vs. 17.6%) compared with patients with HBV-HCC (all P < 0.05). Perioperative mortality and morbidity were comparable between the two groups (1.0% vs. 1.4% and 20.8% vs. 23.2%, both P > 0.05). No differences were noted in median OS and RFS among patient with NAFLD-HCC versus HBV-HCC before or after PSM.
While patients with NAFLD-HCC had different clinical characteristics than patients with HBV-HCC, liver resection resulted in similar perioperative outcomes and comparable OS and RFS among patients with NAFLD-HCC and HBV-HCC.
KeywordsHepatocellular carcinoma Hepatectomy Non-alcoholic fatty liver disease Hepatitis B virus Overall survival Recurrence-free survival
hepatitis B virus
hepatitis C virus
non-alcoholic fatty liver disease
hepatitis E virus
body mass index
American Society of Anesthesiologists
magnetic resonance imaging
propensity score matching
- 95% CI
95% confidence interval.
Conception: Tian Yang, Wan Yee Lau, Feng Shen; Study design: Tian Yang, Lun-Yang Hu, Zhen-Li Li, Jun Han, Hao Xing, Han Wu; Administrative support: Meng-Chao Wu, Feng Shen; Data collection and acquisition: Chao Li, Ming-Da Wang, Yong-Yi Zeng, Ya-Hao Zhou, Ting-Hao Chen, Wei-Min Gu, Hong Wang; Data analysis: Hao Xing, Zhen-Li Li, Jun Han, Tian Yang; Manuscript preparation: Tian Yang, Lun-Yang Hu, Zhen-Li Li, Kai Liu, Jun Han, Hao Xing, Han Wu; Critical revision: Wan Yee Lau, Timothy M. Pawlik, Feng Shen; Final approval of manuscript: All authors.
This work was supported in part by the National Natural Science Foundation of China (No. 81472284 and 81672699), and Shanghai Pujiang Program (No. 16PJD004).
Compliance with Ethical Standards
The study was performed in accordance with the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies of all the six enrolled hospitals.
- 6.Pascale A, Pais R, Ratziu V. An overview of nonalcoholic steatohepatitis: past, present and future directions. J Gastrointestin Liver Dis 2010;19(4):415–23.Google Scholar
- 14.Yang T, Lu JH, Lau WY, Zhang TY, Zhang H, Shen YN, Alshebeeb K, Wu MC, Schwartz M, Shen F. Perioperative blood transfusion does not influence recurrence-free and overall survivals after curative resection for hepatocellular carcinoma: A Propensity Score Matching Analysis. J Hepatol 2016;64(3):583–93.Google Scholar
- 20.Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985;39:33–8.Google Scholar
- 24.Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, Colombo M, Craxi A, Crespo J, Day CP, Geier A, Kondili LA, Lazarus JV, Loomba R, Manns MP, Marchesini G, Negro F, Petta S, Ratziu V, Romero-Gomez M, Sanyal A, Schattenberg JM, Tacke F, Trautwein C, Wei L, Zeuzem S, Razavi H. Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol 2018. DOI: https://doi.org/10.1016/j.jhep.2018.05.036.
- 29.Mittal S, El-Serag HB, Sada YH, Kanwal F, Duan Z, Temple S, May SB, Kramer JR, Richardson PA, Davila JA. Hepatocellular Carcinoma in the Absence of Cirrhosis in United States Veterans is Associated With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2016;14(1):124–31.e1.CrossRefGoogle Scholar
- 33.Salomao M, Yu WM, Brown RS Jr, Emond JC, Lefkowitch JH. Steatohepatitic hepatocellular carcinoma (SH-HCC): a distinctive histological variant of HCC in hepatitis C virus-related cirrhosis with associated NAFLD/NASH. Am J Surg Pathol 2010;34(11):1630–6.Google Scholar
- 34.Viganò L, Conci S, Cescon M, Fava C, Capelli P, D'Errico A, Torzilli G, Di TL, Giuliante F, Vecchio FM, Salizzoni M, David E, Pinna AD, Guglielmi A, Capussotti L. Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: A multicenter matched analysis with HCV-related HCC. J Hepatol 2015;63:93–101.CrossRefGoogle Scholar
- 39.EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69(1):182–236.Google Scholar