title: Surgical outcomes in patients with hepatocellular carcinoma associated with metabolic syndrome.
abstract: BACKGROUND
  Only a few papers have focused on the surgical outcomes of patients with hepatocellular carcinoma (HCC) associated with the metabolic syndrome. We compared the outcomes of patients with metabolic HCC with those of patients with non-B, non-C HCC associated with other etiologies.
  
  
  METHODS
  Metabolic HCC was defined as HCC arising in patients with at least three of the following metabolic disorders: central obesity, dyslipidemia, hypertension, and diabetes mellitus. A total of 246 patients with non-B, non-C HCC were divided into three groups: metabolic HCC (n = 35), alcoholic HCC (n = 114), and cryptogenic HCC (n = 97). Clinical characteristics, surgical data, and survival were compared among the three groups.
  
  
  RESULTS
  Metabolic HCC was diagnosed at a significantly higher age than alcoholic (75 vs. 68 years, P = 0.004) and cryptogenic HCCs (75 vs. 71 years, P = 0.027). Postoperative complications occurred significantly higher in patients with metabolic HCC compared with those with cryptogenic HCC (40.0 vs. 22.7 %, P = 0.049). Especially, pulmonary complications were significant in metabolic HCC compared with cryptogenic HCC (22.9 vs. 8.2 %, P = 0.023). The overall survival rates in the metabolic, alcoholic, and cryptogenic HCC groups were 96.7 % (95 % CI, 90.5-100), 96.3 % (95 % CI, 92.8-99.9), and 95.6 % (95 % CI, 91.5-99.9) at 1 year, respectively, and 87.2 % (95 % CI, 74.5-100), 82.9 % (95 % CI, 74.6-92.2), and 84.5 % (95 % CI, 75.7-94.3) at 3 years, respectively (P = 0.84). The disease-free survival rates in each group were 74.4 % (95 % CI, 60.5-91.5), 76.9 % (95 % CI, 69.2-85.5), and 74.3 % (95 % CI, 65.0-84.8) at 1 year, respectively, and 29.3 % (95 % CI, 16.6-51.8), 39.0 % (95 % CI, 29.7-51.2), and 41.1 % (95 % CI, 29.7-56.8) at 3 years, respectively, (P = 0.90).
  
  
  CONCLUSIONS
  Metabolic HCC patients have specific risks of postoperative complication related to the metabolic syndrome.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan, yoshida.naoki@nihon-u.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshida
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Midorikawa
authors.forename: Tokio
authors.initials: T
authors.lastname: Higaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Masamichi
authors.initials: M
authors.lastname: Moriguchi
authors.forename: Shingo
authors.initials: S
authors.lastname: Tsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications; D018572:Disease-Free Survival; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications; D015996:Survival Rate; D016896:Treatment Outcome