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Association of Concurrent Metabolic Syndrome with Long-term Oncological Prognosis Following Liver Resection for Hepatocellular Carcinoma Among Patients with Chronic Hepatitis B Virus Infection: A Multicenter Study of 1753 Patients



Although hepatitis B virus (HBV) infection remains the main cause of hepatocellular carcinoma (HCC) worldwide, metabolic syndrome, with its increase in prevalence, has become an important and significant risk factor for HCC. This study was designed to investigate the association of concurrent metabolic syndrome with long-term prognosis following liver resection for patients with HBV-related HCC.


From a Chinese, multicenter database, HBV-infected patients who underwent curative resection for HCC between 2010 and 2020 were identified. Long-term oncological prognosis, including overall survival (OS), recurrence-free survival (RFS), and early (≤2 years of surgery) and late (>2 years) recurrences were compared between patients with versus those without concurrent metabolic syndrome.


Of 1753 patients, 163 (9.3%) patients had concurrent metabolic syndrome. Compared with patients without metabolic syndrome, patients with metabolic syndrome had poorer 5-year OS (47.5% vs. 61.0%; P = 0.010) and RFS (28.3% vs. 44.2%; P = 0.003) rates and a higher 5-year overall recurrence rate (67.3% vs. 53.3%; P = 0.024). Multivariate analysis revealed that concurrent metabolic syndrome was independently associated with poorer OS (hazard ratio: 1.300; 95% confidence interval: 1.018–1.660; P = 0.036) and RFS (1.314; 1.062–1.627; P = 0.012) rates, and increased rates of late recurrence (hazard ratio: 1.470; 95% confidence interval: 1.004–2.151; P = 0.047).


In HBV-infected patients with HCC, concurrent metabolic syndrome was associated with poorer postoperative long-term oncologic survival outcomes. These results suggested that patients with metabolic syndrome should undergo enhanced surveillance for tumor recurrence even after 2 years of surgery to early detect late HCC recurrence. Whether improving metabolic syndrome can reduce postoperative recurrence of HCC deserves further exploration.

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This study was supported by the National Natural Science Foundation of China (No. 81972726), Dawn Project Foundation of Shanghai (No. 21SG36), Adjunct Talent Fund of Zhejiang Provincial People’s Hospital (No. 2021-YT), the Natural Science Foundation of Shanghai (No. 22ZR1477900) and Shanghai Science and Technology Committee Rising-Star Program (No. 22QA1411600).


The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations



Conception: M-DW, S-CT, CL, L-YS, XX, WYL, TY; Study design: M-DW, Y-YZ, TY; Administrative support: Y-YZ, FS, TY; Data collection and acquisition: M-DW, CL, S-CT, XX, Y-JL, F-BL, W-MG, X-MW, Y-HZ; Data analysis: M-DW, S-CT, CL, L-QY, Y-KD; Manuscript preparation: M-DW, CL, S-CT, L-YS, XX, L-HG, TY; Critical revision: WYL, FS, Y-YZ, TY; Final approval of manuscript: All authors.

Corresponding authors

Correspondence to Feng Shen MD, PhD, Yong-Yi Zeng MD or Tian Yang MD.

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The study was performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Boards of all the participating hospitals.

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Wang, MD., Tang, SC., Li, C. et al. Association of Concurrent Metabolic Syndrome with Long-term Oncological Prognosis Following Liver Resection for Hepatocellular Carcinoma Among Patients with Chronic Hepatitis B Virus Infection: A Multicenter Study of 1753 Patients. Ann Surg Oncol (2022).

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