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Patients undergoing liver resection for non-alcoholic fatty liver disease-related hepatocellular carcinoma and those for viral hepatitis-related hepatocellular carcinoma have similar survival outcomes

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Abstract

Numerous studies have compared outcomes of liver resection (LR) of patients with non-alcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) to those of patients with non-NAFLD-related HCC. However, results have been inconsistent. We aim to clarify this issue. We enrolled 801 patients with hepatitis B virus (HBV)-related HCC, 433 patients with hepatitis C virus (HCV)-related HCC, and 128 patients with NAFLD-related HCC undergoing LR. Overall survival (OS) and disease-free survival (DFS) of patients with different etiologies of chronic liver disease was compared using the Kaplan–Meier estimator and log-rank test after propensity score matching (PSM). After PSM, 83 patients remained in each group. The groups did not differ significantly in age, sex, the proportion of patients with pathological American Joint Committee on Cancer stage 1, tumor size > 50 mm, receipt of major resection, alpha-fetoprotein (AFP) ≥ 20 ng/ml, presence of cirrhosis, model for end-stage liver disease (MELD) score, and American Society of Anesthesiologists (ASA) classification. The five-year OS of patients with HBV-, HCV-, and NAFLD-related HCC was 78%, 75%, and 78%, respectively (p = 0.789). The five-year DFS of the HBV, HCV, and NAFLD groups was 60%, 45%, and 54%, respectively (p = 0.159). Perioperative morbidity was noted in 17 (20.5%) in the HBV group, 22 (26.5%) in the HCV group, and 15 (18.1%) in the NAFLD group (p = 0.398). The five-year OS, DFS, and perioperative morbidity of patients undergoing LR for NAFLD-related HCC and those for viral hepatitis-related HCC was similar.

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Acknowledgements

The authors thank the Cancer Center, Kaohsiung Chang Gung Memorial Hospital for providing HCC registry data. The authors also thank Chih-Yun Lin, Nien-Tzu Hsu, and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for statistical analyses. This study was supported by Grant CMRPG8L0181 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan. There were no conflicts of interest.

Funding

This study was supported by Grant CMRPG8L0181 from the Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.

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Author notes

  1. Yi-Hao Yen, Chih-Chi Wang and Fang-Ying Kuo equal contribution.

Authors and Affiliations

  1. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan

    Yi-Hao Yen

  2. Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Fang-Ying Kuo & Hock-Liew Eng

  3. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan

    Yueh-Wei Liu, Chee-Chien Yong, Chih-Chi Wang & Wei-Feng Li

  4. Biostatistics Center of Kaohsiung Chang, Gung Memorial Hospital, Kaohsiung, Taiwan

    Chih-Yun Lin

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Contributions

Study conception and design: Y-HY, C-CW. Acquisition of data: all authors Analysis and interpretation of data: C-YL. Drafting of manuscript: F-YK. Critical revision of manuscript: all authors.

Corresponding authors

Correspondence to Yi-Hao Yen or Chih-Chi Wang.

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Conflict of interest

The authors have no conflicts of interest to disclose for all authors.

Ethical approval

The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved this study (Reference number: 202000398B0) and waived the need for informed consent.

Human and animal rights, informed consent

This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital approved this study (Reference number: 202000398B0) and waived the need for informed consent due to the retrospective nature of this study.

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Yen, YH., Kuo, FY., Eng, HL. et al. Patients undergoing liver resection for non-alcoholic fatty liver disease-related hepatocellular carcinoma and those for viral hepatitis-related hepatocellular carcinoma have similar survival outcomes. Updates Surg 76, 879–887 (2024). https://doi.org/10.1007/s13304-024-01833-3

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