Liu Lei, Xie Si, Teng Yu-Xian, Deng Zhu-Jian, Chen Kang, Liu Hao-Tian, Huo Rong-Rui, Liang Xiu-Mei, Guo Ping-Ping, Yang Da-Long, Ma Liang, Xiang Bang-De, Li Le-Qun, Zhong Jian-Hong
Hepatobiliary Surgery Department, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou Workers Hospital, Liuzhou, China.
Hepatobiliary Surgery Department, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning, China.
Front Oncol. 2022 Jan 20;11:783339. doi: 10.3389/fonc.2021.783339. eCollection 2021.
This study aims to determine differences in severity of background liver disease at hepatocellular carcinoma (HCC) diagnosis and long-term survival outcomes among patients undergoing liver resection for HCC in the background of metabolic dysfunction-associated fatty liver disease (MAFLD) compared to chronic hepatitis B (CHB) alone or concurrent CHB (CHB/MAFLD).
Patient demographics and comorbidities, clinicopathologic data, perioperative and long-term outcomes among patients who underwent liver resection for HCC were reviewed. Overall and recurrence-free survival were calculated with the Kaplan-Meier method, with the values compared using the log-rank test.
From January 2014 to December 2018, 1325 patients underwent potential curative liver resection of HCC; 67 (5.0%), 176 (13.3%), and 1082 (81.7%) patients had MAFLD alone, CHB concurrent with MAFLD, and CHB alone, respectively. At HCC diagnosis, fewer MAFLD patients had cirrhosis, alpha fetoprotein concentration ≥ 400 ng/mL, tumor size ≥ 5 cm, mulinodular, microvascular invasion, receiving major hepatectomy, and receiving adjuvant transarterial chemoembolization. After a median follow-up of 47 months after liver resection, MAFLD (or MAFLD plus CHB/MAFLD) patients had significantly higher overall and recurrence-free survival than CHB patients before or after propensity score analysis (all <0.05).
Patients with HCC in the setting of MAFLD have less-severe background liver disease at HCC diagnosis and better long-term survival after curative liver resection compared to counterparts with CHB/MAFLD or CHB.
本研究旨在确定在代谢功能障碍相关脂肪性肝病（MAFLD）背景下接受肝癌肝切除术的患者与单纯慢性乙型肝炎（CHB）或合并慢性乙型肝炎（CHB/MAFLD）患者相比，肝癌诊断时背景肝病的严重程度差异以及长期生存结果。
回顾了接受肝癌肝切除术患者的人口统计学和合并症、临床病理数据、围手术期和长期结果。采用Kaplan-Meier法计算总生存率和无复发生存率，并使用对数秩检验比较这些值。
2014年1月至2018年12月，1325例患者接受了潜在根治性肝癌肝切除术；分别有67例（5.0%）、176例（13.3%）和1082例（81.7%）患者仅患有MAFLD、合并CHB的MAFLD以及单纯CHB。在肝癌诊断时，MAFLD患者中肝硬化、甲胎蛋白浓度≥400 ng/mL、肿瘤大小≥5 cm、多结节、微血管侵犯、接受肝大部切除术以及接受辅助经动脉化疗栓塞的患者较少。肝切除术后中位随访47个月，倾向评分分析前后，MAFLD（或MAFLD加CHB/MAFLD）患者的总生存率和无复发生存率均显著高于CHB患者（均P<0.05）。
与CHB/MAFLD或CHB患者相比，MAFLD背景下的肝癌患者在肝癌诊断时背景肝病较轻，根治性肝切除术后长期生存更好。
