Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
J Am Coll Surg. 2019 Nov;229(5):467-478.e1. doi: 10.1016/j.jamcollsurg.2019.07.012. Epub 2019 Aug 6.
Nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) is on the rise worldwide, but data on long-term outcomes after curative operations are limited. The primary aim of this study was to characterize the perioperative and long-term outcomes after liver resection. The secondary aim was to investigate the influence of the histologic severity of nonalcoholic steatohepatitis and its impact on perioperative outcomes and long-term survival.
A total of 996 patients who underwent liver resection for HCC in our institution were analyzed. Patients were categorized into subgroups of NAFLD vs non-NAFLD HCC based on histologic evidence of hepatic steatosis. Comparisons of patients' demographic, clinical, and surgical characteristics; postoperative complications; and survival outcomes were performed.
Eight hundred and forty-four patients had non-NAFLD HCC and 152 patients had NAFLD HCC. Comorbidities were significantly more common in the NAFLD group (p < 0.0001). In the non-NAFLD group, larger median tumor size, higher liver cirrhosis, and lower median neutrophil to lymphocyte ratio were observed (p < 0.0001). The NAFLD group had a greater amount of intraoperative blood loss, more postoperative complications, and longer length of stay. Five-year overall survival was significantly better in the NAFLD group (p = 0.0355). Significant factors that contribute to poorer survival outcomes include age, congestive cardiac failure, Child-Pugh's class B, cirrhosis, tumor size, multinodularity, and R1 resection. For NAFLD group, patients with abnormal parenchyma showed poorer survival and 5-year overall survival rates (64.8% vs 75.6%; p = 0.2291).
Nonalcoholic fatty liver disease-related HCC is associated with greater surgical morbidity and post-hepatectomy liver failure. Despite this, long-term survival outcomes are favorable compared with non-NAFLD etiologies.
非酒精性脂肪性肝病（NAFLD）相关肝细胞癌（HCC）在全球范围内呈上升趋势，但关于根治性手术后长期结果的数据有限。本研究的主要目的是描述肝切除术后的围手术期和长期结果。次要目的是研究非酒精性脂肪性肝炎的组织学严重程度及其对围手术期结果和长期生存的影响。
分析了在我院行肝切除术治疗 HCC 的 996 例患者。根据肝组织学脂肪变性的证据，将患者分为 NAFLD 与非 NAFLD HCC 亚组。比较患者的人口统计学、临床和手术特征、术后并发症和生存结局。
844 例患者患有非 NAFLD HCC，152 例患者患有 NAFLD HCC。NAFLD 组的合并症明显更为常见（p < 0.0001）。在非 NAFLD 组，观察到更大的肿瘤中位数、更高的肝硬化和更低的中性粒细胞与淋巴细胞比值（p < 0.0001）。NAFLD 组术中出血量更大、术后并发症更多、住院时间更长。NAFLD 组 5 年总生存率明显更高（p = 0.0355）。导致生存结果较差的显著因素包括年龄、充血性心力衰竭、Child-Pugh 分级 B、肝硬化、肿瘤大小、多结节性和 R1 切除。对于 NAFLD 组，表现为异常肝实质的患者生存和 5 年总生存率较差（64.8%比 75.6%；p = 0.2291）。
与非酒精性脂肪性肝病相关的 HCC 与更大的手术发病率和肝切除术后肝衰竭相关。尽管如此，与非 NAFLD 病因相比，长期生存结果是有利的。
