Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis

Wei Zhang; Min Yu Li; Zi Qiang Li; Yong Kang Diao; Xing Kai Liu; Hong Wei Guo; Xiao Chang Wu; Hong Wang; Si Yuan Wang; Ya Hao Zhou; Jun Lu; Kong Ying Lin; Wei Min Gu; Ting Hao Chen; Jie Li; Ying Jian Liang; Lan Qing Yao; Ming Da Wang; Chao Li; Dong Xu Yin; Timothy M. Pawlik; Wan Yee Lau; Feng Shen; Zhong Chen; Tian Yang

doi:10.1016/j.asjsur.2024.07.089

Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis

Wei Zhang, Min Yu Li, Zi Qiang Li, Yong Kang Diao, Xing Kai Liu, Hong Wei Guo, Xiao Chang Wu, Hong Wang, Si Yuan Wang, Ya Hao Zhou, Jun Lu, Kong Ying Lin, Wei Min Gu, Ting Hao Chen, Jie Li, Ying Jian Liang, Lan Qing Yao, Ming Da Wang, Chao Li, Dong Xu YinTimothy M. Pawlik, Wan Yee Lau, Feng Shen, Zhong Chen, Tian Yang

Research output: Contribution to journal › Article › peer-review

Abstract

Background & aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m²), overweight (23.0–27.4 kg/m²) and obese (≥27.5 kg/m²) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06–2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17–2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC. Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence.

Original language	English
Journal	Asian Journal of Surgery
DOIs	https://doi.org/10.1016/j.asjsur.2024.07.089
State	Accepted/In press - 2024
Externally published	Yes

Keywords

Hepatectomy
Hepatocellular carcinoma
Lean
Metabolic dysfunction-associated fatty liver disease
Non-alcoholic fatty liver disease
Recurrence
Survival

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10.1016/j.asjsur.2024.07.089

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Zhang, W., Li, M. Y., Li, Z. Q., Diao, Y. K., Liu, X. K., Guo, H. W., Wu, X. C., Wang, H., Wang, S. Y., Zhou, Y. H., Lu, J., Lin, K. Y., Gu, W. M., Chen, T. H., Li, J., Liang, Y. J., Yao, L. Q., Wang, M. D., Li, C., ... Yang, T. (Accepted/In press). Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis. Asian Journal of Surgery. https://doi.org/10.1016/j.asjsur.2024.07.089

@article{c84d55ebdaa149139fd8851d688a46e2,

title = "Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis",

abstract = "Background & aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06–2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17–2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC. Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence.",

keywords = "Hepatectomy, Hepatocellular carcinoma, Lean, Metabolic dysfunction-associated fatty liver disease, Non-alcoholic fatty liver disease, Recurrence, Survival",

author = "Wei Zhang and Li, {Min Yu} and Li, {Zi Qiang} and Diao, {Yong Kang} and Liu, {Xing Kai} and Guo, {Hong Wei} and Wu, {Xiao Chang} and Hong Wang and Wang, {Si Yuan} and Zhou, {Ya Hao} and Jun Lu and Lin, {Kong Ying} and Gu, {Wei Min} and Chen, {Ting Hao} and Jie Li and Liang, {Ying Jian} and Yao, {Lan Qing} and Wang, {Ming Da} and Chao Li and Yin, {Dong Xu} and Pawlik, {Timothy M.} and Lau, {Wan Yee} and Feng Shen and Zhong Chen and Tian Yang",

note = "Publisher Copyright: {\textcopyright} 2024 Asian Surgical Association and Taiwan Society of Coloproctology",

year = "2024",

doi = "10.1016/j.asjsur.2024.07.089",

language = "English",

journal = "Asian Journal of Surgery",

issn = "1015-9584",

publisher = "Elsevier (Singapore) Pte Ltd",

}

Zhang, W, Li, MY, Li, ZQ, Diao, YK, Liu, XK, Guo, HW, Wu, XC, Wang, H, Wang, SY, Zhou, YH, Lu, J, Lin, KY, Gu, WM, Chen, TH, Li, J, Liang, YJ, Yao, LQ, Wang, MD, Li, C, Yin, DX, Pawlik, TM, Lau, WY, Shen, F, Chen, Z & Yang, T 2024, 'Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis', Asian Journal of Surgery. https://doi.org/10.1016/j.asjsur.2024.07.089

TY - JOUR

T1 - Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts

T2 - A multicenter analysis

AU - Zhang, Wei

AU - Li, Min Yu

AU - Li, Zi Qiang

AU - Diao, Yong Kang

AU - Liu, Xing Kai

AU - Guo, Hong Wei

AU - Wu, Xiao Chang

AU - Wang, Hong

AU - Wang, Si Yuan

AU - Zhou, Ya Hao

AU - Lu, Jun

AU - Lin, Kong Ying

AU - Gu, Wei Min

AU - Chen, Ting Hao

AU - Li, Jie

AU - Liang, Ying Jian

AU - Yao, Lan Qing

AU - Wang, Ming Da

AU - Li, Chao

AU - Yin, Dong Xu

AU - Pawlik, Timothy M.

AU - Lau, Wan Yee

AU - Shen, Feng

AU - Chen, Zhong

AU - Yang, Tian

PY - 2024

Y1 - 2024

N2 - Background & aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06–2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17–2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC. Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence.

AB - Background & aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06–2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17–2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC. Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence.

KW - Hepatectomy

KW - Hepatocellular carcinoma

KW - Lean

KW - Metabolic dysfunction-associated fatty liver disease

KW - Non-alcoholic fatty liver disease

KW - Recurrence

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85199441361&partnerID=8YFLogxK

U2 - 10.1016/j.asjsur.2024.07.089

DO - 10.1016/j.asjsur.2024.07.089

M3 - Article

AN - SCOPUS:85199441361

SN - 1015-9584

JO - Asian Journal of Surgery

JF - Asian Journal of Surgery

ER -

Long-term outcomes following hepatectomy in patients with lean non-alcoholic fatty liver disease-associated hepatocellular carcinoma versus overweight and obese counterparts: A multicenter analysis

Abstract

Keywords

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