Liver Resection for Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: a Multicenter Propensity Matching Analysis with HBV-HCC

  • Tian YangEmail author
  • Lun-Yang Hu
  • Zhen-Li Li
  • Kai Liu
  • Han Wu
  • Hao Xing
  • Wan Yee Lau
  • Timothy M. Pawlik
  • Yong-Yi Zeng
  • Ya-Hao Zhou
  • Wei-Min Gu
  • Hong Wang
  • Ting-Hao Chen
  • Jun Han
  • Chao Li
  • Ming-Da Wang
  • Meng-Chao Wu
  • Feng ShenEmail author
Original Article



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.


Hepatocellular carcinoma Hepatectomy Non-alcoholic fatty liver disease Hepatitis B virus Overall survival Recurrence-free survival 



hepatocellular carcinoma


hepatitis B virus


hepatitis C virus


non-alcoholic fatty liver disease


non-alcoholic steatohepatitis


hepatitis E virus


body mass index


American Society of Anesthesiologists


aspartate transaminase


alanine aminotransferase




computed tomography


magnetic resonance imaging


propensity score matching


overall survival


recurrence-free survival

95% CI

95% confidence interval.


Author’s Contribution

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.

Funding Information

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.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Tian Yang
    • 1
    Email author
  • Lun-Yang Hu
    • 1
    • 2
  • Zhen-Li Li
    • 1
  • Kai Liu
    • 1
  • Han Wu
    • 1
  • Hao Xing
    • 1
  • Wan Yee Lau
    • 1
    • 3
  • Timothy M. Pawlik
    • 4
  • Yong-Yi Zeng
    • 5
  • Ya-Hao Zhou
    • 6
  • Wei-Min Gu
    • 7
  • Hong Wang
    • 8
  • Ting-Hao Chen
    • 9
  • Jun Han
    • 1
  • Chao Li
    • 1
  • Ming-Da Wang
    • 1
  • Meng-Chao Wu
    • 1
  • Feng Shen
    • 1
    Email author
  1. 1.Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Clinical MedicineSecond Military Medical UniversityShanghaiChina
  3. 3.Faculty of MedicineThe Chinese University of Hong KongHong KongChina
  4. 4.Department of Surgery, Wexner Medical CenterOhio State UniversityColumbusUSA
  5. 5.Department of Hepatobiliary Surgery, Mengchao Hepatobiliary HospitalFujian Medical UniversityFuzhouChina
  6. 6.Department of Hepatobiliary SurgeryPu’er People’s HospitalPu’erChina
  7. 7.The First Department of General SurgeryThe Fourth Hospital of HarbinHarbinChina
  8. 8.Department of General SurgeryLiuyang People’s HospitalLiuyangChina
  9. 9.Department of General SurgeryZiyang First People’s HospitalZiyangChina

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