Metabolic Syndrome Leads to Worse Outcomes For Patients With HBV-Related HCC

Metabolic syndrome is associated with poorer overall survival for patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC).

A team led by Ming-Da Wang, MD, Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), identified the association between concomitant metabolic syndrome and long-term prognosis after liver resection in patients with HBV-related HCC.


While HBV infection is the leading cause of HCC worldwide, metabolic syndrome is also an important and significant risk factor for HCC.

In the multi-center database study, researchers identified patients with HBV who underwent curative HCC resection in China between 2010 and 2020 and compared long-term oncologic prognosis, including overall survival, relapse-free survival, and early and late relapses between patients with and without metabolic syndrome Syndrome.

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A total of 1753 patients were included in the study, of which 9.3% (n = 163) had concomitant metabolic syndrome.

Outcomes with Metabolic Syndrome

Patients with metabolic syndrome had a poorer 5-year overall survival than patients without metabolic syndrome (47.5% vs. 61.0%; P = 0.010). They also had poorer recurrence-free survival rates (28.3% vs. 44.2%; P = 0.003) and a higher 5-year overall recurrence rate (67.3% vs. 53.3%; P = 0.024).

After performing a multivariate analysis, the researchers found that concomitant metabolic syndrome was independently associated with poorer overall survival (HR, 1300; 95% CI, 1018-1660; P = 0.036) and recurrence-free survival rates (HR, 1.314; 95% CI, 1.062-1.627; P = 0.012).

There were also increased late recurrence rates (HR, 1.470; 95% CI, 1.004-2.151; P = 0.047).

“In HBV-infected patients with HCC, concomitant metabolic syndrome was associated with poorer long-term postoperative oncologic survival outcomes,” the authors wrote. “These results suggested that patients with metabolic syndrome should be subjected to increased surveillance for tumor recurrence even after 2 years of surgery for early detection of late HCC recurrence. Whether improvement of the metabolic syndrome can reduce the postoperative recurrence of HCC deserves further investigation.”

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Recently, a team led by Nobuhiro Hattori, Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, identified the risk factors associated with liver-related and non-liver-related mortality in patients with hepatitis C virus (HCV). sustained virologic response to direct-acting antivirals in HCC and diabetes mellitus.

The results show a cumulative liver-related or non-liver-related mortality rate of 0.00 or 1.29% at year 1, compared to 2.87 or 3.60% at year 3 and 5.10 or 9.46% at year 5.

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For liver-related deaths, 90% (n=9) were due to liver cancer, while the most common cause of non-liver-related deaths was malignancy.

After performing a multivariate analysis using the Cox proportional hazards model, the researchers found diabetes mellitus (HR, 13.1; 95% CI, 2.81-61.3) and a history of hepatocellular carcinoma (HR, 12, 8; 95% CI, 2.76-59.2), independently predicted liver-related death. There were no variables related to non-liver-related death.

The study “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” was published online in Annals of Surgical Oncology.

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