Fu Jia, Jiang Jinqiong, Liu Kanghan
Department of Oncology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Hunan Normal University, Changsha, China.
Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Hunan Normal University, Hunan Clinical Research Center for Chronic Kidney Disease, Changsha, China.
Front Oncol. 2023 Feb 23;13:1117846. doi: 10.3389/fonc.2023.1117846. eCollection 2023.
Metabolic syndrome (MetS) has been related to a high incidence of hepatocellular carcinoma (HCC). However, the influence of MetS on survival of patients with HCC is still unclear. We performed a systematic review and meta-analysis to evaluate the association between MetS and survival of HCC patients.
A search of PubMed, Embase, and Web of Science retrieved relevant cohort studies from the inception of the databases to October 16, 2022. Data collection, literature search, and statistical analysis were carried out independently by two authors. We pooled the results using a random-effects model that incorporates heterogeneity.
In the meta-analysis, 8080 patients with HCC were included from ten cohort studies, and 1166 patients (14.4%) had MetS. Eight studies included patients treated primarily with radical hepatectomy, one study with patients receiving sorafenib, and another study included patients who were treated with radical hepatectomy or non-surgical treatments. Pooled results showed that MetS was associated with poor overall survival (OS, risk ratio [RR]: 1.21, 95% confidence interval [CI]:1.08 to 1.37, p = 0.001; I = 32%) and progression-free survival (PFS, RR: 1.33, 95% CI: 1.18 to 1.49, p < 0.001, I = 14%). Influencing analysis by excluding one study at a time showed consistent results (p all < 0.05). Subgroup analyses showed similar results in studies with MetS diagnosed with the National Cholesterol Education Program Adult Treatment Panel III or International Diabetes Federal criteria, and in studies with mean follow-up durations < or ≥ 3.5 years (p for subgroup difference all > 0.05).
In patients with HCC, MetS may be a risk factor of poor OS and PFS, particularly for those after radical hepatectomy.
代谢综合征（MetS）与肝细胞癌（HCC）的高发病率相关。然而，MetS对HCC患者生存的影响仍不明确。我们进行了一项系统评价和荟萃分析，以评估MetS与HCC患者生存之间的关联。
检索PubMed、Embase和Web of Science数据库，获取从数据库建立至2022年10月16日的相关队列研究。由两名作者独立进行数据收集、文献检索和统计分析。我们使用纳入异质性的随机效应模型汇总结果。
在荟萃分析中，纳入了来自十项队列研究的8080例HCC患者，其中1166例（14.4%）患有MetS。八项研究纳入了主要接受根治性肝切除术治疗的患者，一项研究纳入了接受索拉非尼治疗的患者，另一项研究纳入了接受根治性肝切除术或非手术治疗的患者。汇总结果显示，MetS与总体生存期（OS）较差相关（风险比[RR]：1.21，95%置信区间[CI]：1.08至1.37，p = 0.001；I² = 32%）和无进展生存期（PFS）较差相关（RR：1.33，95%CI：1.18至1.49，p < 0.001，I² = 14%）。每次排除一项研究进行的影响分析显示结果一致（所有p < 0.05）。亚组分析显示，在使用美国国家胆固醇教育计划成人治疗小组第三次报告（National Cholesterol Education Program Adult Treatment Panel III）或国际糖尿病联盟标准（International Diabetes Federal criteria）诊断MetS的研究中，以及在平均随访时间<或≥3.5年的研究中，结果相似（亚组差异的p均> 0.05）。
在HCC患者中，MetS可能是OS和PFS较差的危险因素，尤其是对于根治性肝切除术后的患者。
