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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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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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Acknowledgment

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).

Funding

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.

Author information

Author notes

  1. Ming Da Wang, Shi Chuan Tang, Chao Li, Li Yang Sun and Xiao Xu have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China

    Ming-Da Wang MD, Chao Li MD, Lan-Qing Yao MD, Yong-Kang Diao MD, Li-Hui Gu MD, Feng Shen MD, PhD & Tian Yang MD

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

    Shi-Chuan Tang MD, Wan Yee Lau MD, FRCS, FACS, FRACS (Hon), Yong-Yi Zeng MD & Tian Yang MD

  3. Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Cancer Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China

    Li-Yang Sun MD & Cheng-Wu Zhang MD

  4. Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China

    Xiao Xu MD

  5. Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China

    Ying-Jian Liang MD

  6. Department of Hepatobiliary Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    Fu-Bao Liu MD

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

    Wei-Min Gu MD

  8. Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong, China

    Xian-Ming Wang MD

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

    Ya-Hao Zhou MD

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

    Wan Yee Lau MD, FRCS, FACS, FRACS (Hon)

  11. Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Navy Medical University, Shanghai, China

    Feng Shen MD, PhD & Tian Yang MD

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  1. Ming-Da Wang MD
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Contributions

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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Ethical Approval

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 30, 346–358 (2023). https://doi.org/10.1245/s10434-022-12529-6

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