title: Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: A multicenter matched analysis with HCV-related HCC.
abstract: OBJECTIVE
  The incidence of metabolic syndrome-related hepatocellular carcinoma (MS-HCC) is increasing worldwide. High resection risks are anticipated because of underlying steatohepatitis, but long-term results are unknown. To clarify the outcomes following liver resection in patients with MS-HCC and to compare the outcomes of MS-HCC to HCV-related HCC (HCV-HCC).
  
  
  METHODS
  All the consecutive patients undergoing liver resection for HCC in six high-volume HPB units between 2000 and 2012 were retrospectively considered. The patients with MS-HCC were identified and matched one-to-one with HCV-HCC patients without metabolic syndrome. Matching was based on age, cirrhosis, Child-Pugh class, portal hypertension, HCC number and diameter and liver resection extension.
  
  
  RESULTS
  Among 1563 patients undergoing liver resection for HCC in the study period, 96 (6.1%) had MS-HCC. They were matched with 96 HCV-HCC patients. All patients were Child-Pugh class A, 22.9% had cirrhosis. Forty-one patients per group (42.7%) required major hepatectomy. The MS-HCC group had a higher prevalence of steatohepatitis (25.0% vs. 9.4%, p=0.004). Operative mortality was 2.1% (1 MS-HCC, 3 HCV-HCC, p=0.621). Morbidity and liver failure rates were similar between the two groups. In the multivariate analysis, cirrhosis, major hepatectomy, and MELD >8, but not steatohepatitis, impacted severe morbidity and liver failure rates. The MS-HCC group had better 5-year overall survival (65.6% vs. 61.4%, p=0.031) and recurrence-free survival (37.0% vs. 27.5%, p=0.077). Independent negative prognostic factors were HCV-HCC, multiple HCC, microvascular invasion, and satellite nodules.
  
  
  CONCLUSIONS
  Liver resection is safe for MS-HCC, as for HCV-HCC. Cirrhosis, but not steatohepatitis, affects short-term outcomes. MS-HCC is associated with excellent long-term outcomes, better than HCV-HCC.
authors: Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy; Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy. Electronic address: luca.vigano@humanitas.it.
authors: Luca
authors: L
authors: Viganò
authors: Department of Surgery, Unit of HPB Surgery, GB Rossi University Hospital, Verona, Italy.
authors: Simone
authors: S
authors: Conci
authors: Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors: Matteo
authors: M
authors: Cescon
authors: Department of Pathology, Ospedale Mauriziano Umberto I, Torino, Italy.
authors: Cristina
authors: C
authors: Fava
authors: Department of Pathology, University Hospital, Verona, Italy.
authors: Paola
authors: P
authors: Capelli
authors: Department of Pathology, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors: Antonietta
authors: A
authors: D'Errico
authors: Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Rozzano (MI), Italy.
authors: Guido
authors: G
authors: Torzilli
authors: Department of Pathology, Humanitas Clinical and Research Center, Rozzano (MI), Italy.
authors: Luca
authors: L
authors: Di Tommaso
authors: Hepatobiliary Unit, Department of Surgery, Catholic University of the Sacred Heart, Roma, Italy.
authors: Felice
authors: F
authors: Giuliante
authors: Department of Pathology, Catholic University of the Sacred Heart, Roma, Italy.
authors: Fabio Maria
authors: FM
authors: Vecchio
authors: Department of Surgery and Liver Transplantation, A.O. Città della Salute e della Scienza, Torino, Italy.
authors: Mauro
authors: M
authors: Salizzoni
authors: Department of Pathology, A.O. Città della Salute e della Scienza, Torino, Italy.
authors: Ezio
authors: E
authors: David
authors: Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
authors: Antonio Daniele
authors: AD
authors: Pinna
authors: Department of Surgery, Unit of HPB Surgery, GB Rossi University Hospital, Verona, Italy.
authors: Alfredo
authors: A
authors: Guglielmi
authors: Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy.
authors: Lorenzo
authors: L
authors: Capussotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery* / Q000821:virology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cirrhosis; HCV-related HCC; Hepatocellular carcinoma; Liver failure; Liver surgery; Metabolic syndrome; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Obesity; Steatosis; Survival