| PART 1 Outcomes of Liver Resection for Metabolic Dysfunction-Associated Fatty Liver Disease or Chronic Hepatitis B-Related HCCObjective: This study aims to determine differences in severity of background liver disease at HCC diagnosis and long-term survival outcomes among patients undergoing liver resection for HCC in the background of MAFLD compared to CHB alone or concurrent CHB(CHB/MAFLD).Method: 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.Results: 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/ m L,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 P<0.05).Conclusion: 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.PART 2 Meta-analysis of the Prognosis after Hepatectomy for NAFLD/ MAFLD-Associated Hepatocellular CarcinomaObjective: To compare and systematically review the prognosis after hepatectomy with NAFLD/ MAFLD-associated hepatocellular carcinoma versus other risk factors.Method: Pub Med,EMBASE,Scopus and CNCID databases were searched to screen and collect high-quality cohort or case-control studies on the outcome after hepatectomy for NAFLD/ MAFLD-associated hepatocellular carcinoma from 1980 to 2021.Meta-analysis was performed using Rev Man(version 5.4.0)and R(version 3.5.0)statistical software.Results: Fifteen studies containing 10302 cases were included.There were 2,312 cases(22.4%)of NAFLD/MAFLD related HCC,and 7,990 cases(77.6%)of other etiology related HCC.Meta-analysis showed that the incidence of perioperative complications(P=0.662)and mortality(P=0.083)were similar in the observation group(NAFLD/MAFLD related HCC)and the control group,and the OS(HR 0.89,95%ci 0.78-1.01,P=0.08;)and RFS(HR 0.94,95%CI 0.85-1.04,P=0.21)had no significant difference.However,regional subgroup analysis showed that in Asian cases,the OS of NAFLD/MAFLD-related HCC was significantly better than the other etiologically related HCC(HR 0.83,95%CI 0.71-0.97,P=0.02).Conclusion: The short-term outcome(major perioperative complications and mortality)and long-term prognosis(OS and RFS)of hepatectomy for HCC patients with NAFLD/MAFLD were similar to the control group.However,Asian patients with NAFLD/ MAFLD-related HCC may have better long-term survival.PART 3 Comparison of Total Tumor Volume and Tumor Burden Score in Predicting Prognosis of HCC Patients Concurrent with Fatty Liver Disease or Metabolic-Dysfunction Associated Fatty Liver DiseaseObjective: To compare the prognostic value of TTV and TBS in HCC patients concurrent with FLD-HCC or MAFLD-HCCMethod: Patients who were diagnosed with FLD-HCC and received hepatic resection from January 2010 to December 2018 were retrospectively analyzed.Subgroup analyses were performed on MAFLD-HCC patients.The optimal cutoff values of TTV and TBS were obtained using X-tile software.Overall survival rates between different groups were compared using Kaplan-Meier method.Timedependent receiver operator characteristic curve(ROC)analyses were performed to evaluate the predictive performance of TTV and TBS for stratifying overall survival in MAFLD-HCC patients.Correlation analysis was carried outon TTV and TBS to evaluate their relationship in estimating tumor burden.Coxregression analyses were performed to determine the independent risk factors ofoverall survival.Results: A total of 432 FLD-HCC patients were included in this retrospective study.Among the study cohort,301 patients were diagnosed with MAFLD-HCC.The optimal cutoff values were 65.6 cm3 and 382.6 cm3 for TTV and 6.3 points and 9.1 points for TBS.Median TTV was 87.1(22.4-267.9)cm3 and the median TBS was 5.4(3.8-8.1)points.The results showed that the overall survival of patients in the low TTV /TBS group were significantly better than those in the medium or high TTV/TBS group(all P<0.001).Correlation analysis indicated that the correlation coefficients of TTV and TBS in FLD-HCC and MAFLD-HCC patients were 0.864 and 0.854,respectively.Multivariate Cox regression analysis indicated that CHB,AFP≥400ng/ml,TTV and TBS were independent risk factors for FLD-HCC/MAFLD-HCC patients(all P<0.001).Time-dependent ROC analysis indicated that TTV and TBS showed comparable discriminative ability in predicting overall survival of FLD-HCC or MAFLD-HCC patients.Moreover,The predictive performance were alsosimilar in FLD-HCC and MAFLD-HCC patients.Conclusion: TTV and TBS were both effective in predicting prognosis of HCC patients concurrent with fatty liver disease or metabolic associated fatty liver disease. |
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