Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
Br J Surg. 2013 Jan;100(1):113-21. doi: 10.1002/bjs.8963. Epub 2012 Nov 12.
The incidence of metabolic syndrome-associated hepatocellular carcinoma (MS-HCC) is increasing. However, the results following liver resection in this context have not been described in detail.
Data for all patients with metabolic syndrome as a unique risk factor for HCC who underwent liver resection between 2000 and 2011 were retrieved retrospectively from an institutional database. Pathological analysis of the underlying parenchyma included fibrosis and non-alcoholic fatty liver disease activity score. Patients were classified as having normal or abnormal underlying parenchyma. Their characteristics and outcomes were compared.
A total of 560 resections for HCC were performed in the study interval. Sixty-two patients with metabolic syndrome, of median age 70 (range 50-84) years, underwent curative hepatectomy for HCC, including 32 major resections (52 per cent). Normal underlying parenchyma was present in 24 patients (39 per cent). The proportion of resected HCCs labelled as MS-HCC accounted for more than 15 per cent of the entire HCC population in more recent years. Mortality and major morbidity rates were 11 and 58 per cent respectively. Compared with patients with normal underlying liver, patients with abnormal liver had increased rates of mortality (0 versus 18 per cent; P = 0·026) and major complications (13 versus 42 per cent; P = 0·010). In multivariable analysis, a non-severely fibrotic yet abnormal underlying parenchyma was a risk factor for major complications (hazard ratio 5·66, 95 per cent confidence interval 1·21 to 26·52; P = 0·028). The 3-year overall and disease-free survival rates were 75 and 70 per cent respectively, and were not influenced by the underlying parenchyma.
HCC in patients with metabolic syndrome is becoming more common. Liver resection is appropriate but carries a high risk, even in the absence of severe fibrosis. Favourable long-term outcomes justify refinements in the perioperative management of these patients.
代谢综合征相关肝细胞癌（MS-HCC）的发病率正在上升。然而，在这种情况下行肝切除术的结果尚未详细描述。
从机构数据库中回顾性检索了 2000 年至 2011 年间所有以代谢综合征为 HCC 唯一危险因素而行肝切除术的患者的数据。对基础实质的病理分析包括纤维化和非酒精性脂肪性肝病活动评分。将患者分为基础实质正常和异常。比较其特征和结局。
研究期间共行 560 例 HCC 切除术。62 例代谢综合征患者（中位年龄 70 岁[范围 50-84 岁]）接受 HCC 根治性肝切除术，其中 32 例为大切除术（52%）。24 例（39%）患者基础实质正常。近年来，被标记为 MS-HCC 的 HCC 切除比例占整个 HCC 人群的 15%以上。死亡率和主要并发症发生率分别为 11%和 58%。与基础肝正常的患者相比，基础肝异常的患者死亡率（0 比 18%；P=0·026）和主要并发症发生率（13 比 42%；P=0·010）更高。多变量分析显示，非严重纤维化但基础实质异常是发生主要并发症的危险因素（风险比 5·66，95%置信区间 1·21 至 26·52；P=0·028）。3 年总生存率和无病生存率分别为 75%和 70%，不受基础实质的影响。
代谢综合征患者的 HCC 越来越常见。即使没有严重纤维化，肝切除术也是合适的，但风险很高。有利的长期结果证明需要对这些患者进行围手术期管理的细化。
