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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

HCC:

hepatocellular carcinoma

HBV:

hepatitis B virus

HCV:

hepatitis C virus

NAFLD:

non-alcoholic fatty liver disease

NASH:

non-alcoholic steatohepatitis

HEV:

hepatitis E virus

BMI:

body mass index

ASA:

American Society of Anesthesiologists

AST:

aspartate transaminase

ALT:

alanine aminotransferase

AFP:

alpha-fetoprotein

CT:

computed tomography

MRI:

magnetic resonance imaging

PSM:

propensity score matching

OS:

overall survival

RFS:

recurrence-free survival

95% CI:

95% confidence interval.

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Funding

This work was supported in part by the National Natural Science Foundation of China (No. 81472284 and 81672699), and Shanghai Pujiang Program (No. 16PJD004).

Author information

Author notes

  1. Tian Yang, Lun-Yang Hu, Zhen-Li Li, Kai Liu, Han Wu and Hao Xing contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China

    Tian Yang, Lun-Yang Hu, Zhen-Li Li, Kai Liu, Han Wu, Hao Xing, Wan Yee Lau, Jun Han, Chao Li, Ming-Da Wang, Meng-Chao Wu & Feng Shen

  2. Department of Clinical Medicine, Second Military Medical University, Shanghai, China

    Lun-Yang Hu

  3. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China

    Wan Yee Lau

  4. Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik

  5. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, Fujian, China

    Yong-Yi Zeng

  6. Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, Yunnan, China

    Ya-Hao Zhou

  7. The First Department of General Surgery, The Fourth Hospital of Harbin, Harbin, Heilongjiang, China

    Wei-Min Gu

  8. Department of General Surgery, Liuyang People’s Hospital, Liuyang, Hunan, China

    Hong Wang

  9. Department of General Surgery, Ziyang First People’s Hospital, Ziyang, Sichuan, China

    Ting-Hao Chen

Authors
  1. Tian Yang
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Contributions

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.

Corresponding authors

Correspondence to Tian Yang or Feng Shen.

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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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Yang, T., Hu, LY., Li, ZL. et al. Liver Resection for Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: a Multicenter Propensity Matching Analysis with HBV-HCC. J Gastrointest Surg 24, 320–329 (2020). https://doi.org/10.1007/s11605-018-04071-2

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