Hepatic Resection for Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Michele Molinari, MD, MSc; Christof Kaltenmeier, MD; Patrick-Bou Samra, MD; Hao Liu, MD, PhD; Charles Wessel, MLS; Mary Lou Klem, MLS; Stalin Dharmayan, MD; Bishoy Emmanuel, MD; Hasan Al Harakeh, MD; Samer Tohme, MD; David Geller, MD; Amit Tevar, MD; Christopher B. Hughes, MD; Abhinav Humar, MD; Ramon Bataller, MD, PhD; Jaideep Behari, MD

doi:10.1097/AS9.0000000000000065

Annals of Surgery Open (Jun 2021)

Hepatic Resection for Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Michele Molinari, MD, MSc,
Christof Kaltenmeier, MD,
Patrick-Bou Samra, MD,
Hao Liu, MD, PhD,
Charles Wessel, MLS,
Mary Lou Klem, MLS,
Stalin Dharmayan, MD,
Bishoy Emmanuel, MD,
Hasan Al Harakeh, MD,
Samer Tohme, MD,
David Geller, MD,
Amit Tevar, MD,
Christopher B. Hughes, MD,
Abhinav Humar, MD,
Ramon Bataller, MD, PhD,
Jaideep Behari, MD

Affiliations

Michele Molinari, MD, MSc: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Christof Kaltenmeier, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Patrick-Bou Samra, MD: † Department of Surgery, Division of General Surgery, Johns Hopkins University, Baltimore, MD
Hao Liu, MD, PhD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Charles Wessel, MLS: ‡ Medical Health Library Services, University of Pittsburgh, Pittsburgh, PA
Mary Lou Klem, MLS: ‡ Medical Health Library Services, University of Pittsburgh, Pittsburgh, PA
Stalin Dharmayan, MD: § Department of Surgery, Division of Transplant Surgery, University of Leeds, Leeds, United Kingdom
Bishoy Emmanuel, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Hasan Al Harakeh, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Samer Tohme, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
David Geller, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Amit Tevar, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Christopher B. Hughes, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Abhinav Humar, MD: From the * Department of Surgery, Division of Transplant Surgery, University of Pittsburgh, Pittsburgh, PA
Ramon Bataller, MD, PhD: ∥ Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA.
Jaideep Behari, MD: ∥ Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA.

DOI: https://doi.org/10.1097/AS9.0000000000000065
Journal volume & issue: Vol. 2, no. 2
p. e065

Abstract

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Objective:. To systematically review and compare the overall (OS) and disease-free (DFS) survival after hepatic resections for hepatocellular carcinoma (HCC) of patients with nonalcoholic fatty liver disease (NAFLD) versus other risk factors. Background:. Different clinical and tumor characteristics are associated with HCC in the setting of NAFLD in comparison to other risk factors. It is still unclear whether these differences impact patient survival after radical hepatectomies. Methods:. Randomized controlled trials and observational studies published in the English literature between July 1980 and June 2020 were searched using multiple databases. Patients’ baseline characteristics and the hazard ratios (HRs) of the OS and DFS were extracted and meta-analyses were performed. Results:. Fifteen retrospective cohort studies with a total of 7226 patients were included. Among them, 1412 patients (19.5%) had NAFLD and 5814 (80.4%) had other risk factors (eg, viral hepatitis B or C, alcoholic cirrhosis, or cryptogenic cirrhosis). Summary statistics showed that patients with NAFLD had better DFS (HR = 0.81; 95% CI: 0.70–0.94; P = 0.006) and OS (HR = 0.78; 95% CI: 0.67–0.90; P = 0.001) than the control group. Subgroups analyses also indicated that the OS favored NAFLD patients versus patients with viral hepatitis B or C (HR = 0.80; 95% CI: 0.67–0.96; P = 0.017) or alcoholic and cryptogenic cirrhosis (HR = 0.68; 95% CI: 0.47–1.0; P = 0.05). Conclusion:. After hepatic resections for HCC, NAFLD patients have better DFS and OS than patients with other risk factors. Subgroup analysis and meta-regression suggested that the survival advantage of NAFLD patients was more pronounced in studies published after 2015 and from Asian centers.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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