Tsai Feng-Pai, Su Tung-Hung, Huang Shang-Chin, Tseng Tai-Chung, Hsu Shih-Jer, Liao Sih-Han, Hong Chun-Ming, Liu Chen-Hua, Yang Hung-Chih, Liu Chun-Jen, Chen Pei-Jer, Kao Jia-Horng
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan.
Cancer. 2025 Jan 1;131(1):e35541. doi: 10.1002/cncr.35541. Epub 2024 Sep 6.
Steatotic liver disease (SLD) is an emerging liver disease that has been associated with an increased risk for hepatocellular carcinoma (HCC). The impact of concurrent SLD on the prognosis of HCC remains unknown. This study investigates how concurrent SLD affects the outcomes of patients with HCC undergoing curative radiofrequency ablation (RFA) therapy.
A retrospective analysis of patients with early-stage HCC receiving curative RFA at a tertiary medical center was conducted. Laboratory data and HCC characteristics were recorded and analyzed by a Cox proportional hazards regression model to predict recurrence and all-cause mortality after RFA.
A total of 598 patients with HCC were included between 2005 and 2015, with 139 and 459 classified in SLD and non-SLD groups, respectively. The SLD group exhibited a significantly better liver reserve and a lower cumulative incidence of HCC recurrence and liver-related and all-cause mortality after a median follow-up of 51 months. After adjusting for metabolic dysfunction, liver reserve, and HCC characteristics, the presence of SLD reduced all-cause mortality (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.45-0.996; p = .048), which was supported by inverse probability weighting analysis (aHR, 0.65; 95% CI, 0.42-1.00; p = .049). Poor liver functional reserve (high albumin-bilirubin grades) increased all-cause mortality dose dependently. Barcelona Clinic Liver Cancer staging and a higher Fibrosis-4 index were predictors for HCC recurrence, whereas SLD was not.
Among patients with HCC undergoing curative RFA, those with concurrent SLD had a lower risk of all-cause mortality compared to those with poor liver functional reserve.
The present research demonstrated that patients with both liver cancer and steatotic liver disease who received curative radiofrequency ablation for liver cancer survived longer compared to those without steatotic liver disease. Maintaining good liver function is an important prognostic factor for survival.
脂肪性肝病（SLD）是一种新兴的肝脏疾病，与肝细胞癌（HCC）风险增加相关。同时存在的SLD对HCC预后的影响尚不清楚。本研究调查了同时存在的SLD如何影响接受根治性射频消融（RFA）治疗的HCC患者的预后。
对一家三级医疗中心接受根治性RFA的早期HCC患者进行回顾性分析。记录实验室数据和HCC特征，并通过Cox比例风险回归模型进行分析，以预测RFA后的复发和全因死亡率。
2005年至2015年间共纳入598例HCC患者，其中139例和459例分别归入SLD组和非SLD组。中位随访51个月后，SLD组的肝脏储备明显更好，HCC复发以及肝脏相关和全因死亡率的累积发生率更低。在调整代谢功能障碍、肝脏储备和HCC特征后，SLD的存在降低了全因死亡率（调整后风险比[aHR]，0.67；95%置信区间[CI]，0.45 - 0.996；p = 0.048），逆概率加权分析也支持这一结果（aHR，0.65；95% CI，0.42 - 1.00；p = 0.049）。肝功能储备差（高白蛋白 - 胆红素分级）会剂量依赖性地增加全因死亡率。巴塞罗那临床肝癌分期和较高的纤维化 - 4指数是HCC复发的预测因素，而SLD不是。
在接受根治性RFA的HCC患者中，与肝功能储备差的患者相比，同时存在SLD的患者全因死亡率风险更低。
本研究表明，接受肝癌根治性射频消融治疗的肝癌合并脂肪性肝病患者比无脂肪性肝病患者存活时间更长。维持良好肝功能是生存的重要预后因素。
