| Contributors: |
Berardi, G.; Cucchetti, A.; Sposito, C.; Ratti, F.; Nebbia, M.; D'Souza, D. M.; Pascual, F.; Dogeas, E.; Tohme, S.; Vitale, A.; D'Amico, F. E.; Alessandris, R.; Panetta, V.; Simonelli, I.; Colasanti, M.; Russolillo, N.; Moro, A.; Fiorentini, G.; Serenari, M.; Rotellar, F.; Zimitti, G.; Famularo, S.; Ivanics, T.; Donando, F. G.; Hoffman, D.; Onkendi, E.; Essaji, Y.; Giuliani, T.; Lopez Ben, S.; Caula, C.; Rompianesi, G.; Chopra, A.; Abu Hilal, M.; Sapisochin, G.; Torzilli, G.; Corvera, C.; Alseidi, A.; Helton, S.; Troisi, R. I.; Simo, K.; Conrad, C.; Cescon, M.; Cleary, S.; Kwon, D. C. H.; Ferrero, A.; Ettorre, G. M.; Cillo, U.; Geller, D.; Cherqui, D.; Serrano, P. E.; Ferrone, C.; Aldrighetti, L.; Kingham, T. P.; Mazzaferro, V. |
| Description: |
Background & Aims: Metabolic syndrome (MS) is a growing epidemic and a risk factor for the development of hepatocellular carcinoma (HCC). This study investigated the long-term outcomes of liver resection (LR) for HCC in patients with MS. Rates, timing, patterns, and treatment of recurrences were investigated, and cancer-specific survivals were assessed. Methods: Between 2001 and 2021, data from 24 clinical centers were collected. Overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival were analyzed as well as recurrence patterns and treatment. The analysis was conducted using a competing-risk framework. The trajectory of the risk of recurrence over time was applied to a competing risk analysis. For post-recurrence survival, death resulting from tumor progression was the primary endpoint, whereas deaths with recurrence relating to other causes were considered as competing events. Results: In total, 813 patients were included in the study. Median OS was 81.4 months (range 28.1–157.0 months), and recurrence occurred in 48.3% of patients, with a median RFS of 39.8 months (range 15.7–174.7 months). Cause-specific hazard of recurrence showed a first peak 6 months (0.027), and a second peak 24 months (0.021) after surgery. The later the recurrence, the higher the chance of receiving curative intent approaches (p = 0.001). Size >5 cm, multiple tumors, microvascular invasion, and cirrhosis were independent predictors of recurrence showing a cause-specific hazard over time. RFS was associated with death for recurrence (hazard ratio: 0.985, 95% CI: 0.977–0.995; p = 0.002). Conclusions: Patients with MS undergoing LR for HCC have good long-term survival. Recurrence occurs in 48% of patients with a double-peak incidence and time-specific hazards depending on tumor-related factors and underlying disease. The timing of recurrence significantly impacts survival. Surveillance after resection should be adjusted over time depending on risk factors. Impact and implications: Metabolic syndrome (MS) ... |