Liver resection for hepatocellular carcinoma in patients with metabolic syndrome: A multicenter matched analysis with HCV-related HCC

Luca Viganò, Simone Conci, Matteo Cescon, Cristina Fava, Paola Capelli, Antonietta D'Errico, Guido Torzilli, Luca Di Tommaso, Felice Giuliante, Fabio Maria Vecchio, Mauro Salizzoni, Ezio David, Antonio Daniele Pinna, Alfredo Guglielmi, Lorenzo Capussotti

Research output: Contribution to journalArticlepeer-review


Background & Aims The incidence of metabolic syndrome-related hepatocellular carcinoma (MS-HCC) is increasing worldwide. High resection risks are anticipated because of underlying steatohepatitis, but long-term results are unknown. To clarify the outcomes following liver resection in patients with MS-HCC and to compare the outcomes of MS-HCC to HCV-related HCC (HCV-HCC). Methods All the consecutive patients undergoing liver resection for HCC in six high-volume HPB units between 2000 and 2012 were retrospectively considered. The patients with MS-HCC were identified and matched one-to-one with HCV-HCC patients without metabolic syndrome. Matching was based on age, cirrhosis, Child-Pugh class, portal hypertension, HCC number and diameter and liver resection extension. Results Among 1563 patients undergoing liver resection for HCC in the study period, 96 (6.1%) had MS-HCC. They were matched with 96 HCV-HCC patients. All patients were Child-Pugh class A, 22.9% had cirrhosis. Forty-one patients per group (42.7%) required major hepatectomy. The MS-HCC group had a higher prevalence of steatohepatitis (25.0% vs. 9.4%, p = 0.004). Operative mortality was 2.1% (1 MS-HCC, 3 HCV-HCC, p = 0.621). Morbidity and liver failure rates were similar between the two groups. In the multivariate analysis, cirrhosis, major hepatectomy, and MELD >8, but not steatohepatitis, impacted severe morbidity and liver failure rates. The MS-HCC group had better 5-year overall survival (65.6% vs. 61.4%, p = 0.031) and recurrence-free survival (37.0% vs. 27.5%, p = 0.077). Independent negative prognostic factors were HCV-HCC, multiple HCC, microvascular invasion, and satellite nodules. Conclusions Liver resection is safe for MS-HCC, as for HCV-HCC. Cirrhosis, but not steatohepatitis, affects short-term outcomes. MS-HCC is associated with excellent long-term outcomes, better than HCV-HCC.

Original languageEnglish
Article number5527
Pages (from-to)93-101
Number of pages9
JournalJournal of Hepatology
Issue number1
Publication statusPublished - Jul 1 2015


  • Cirrhosis
  • HCV-related HCC
  • Hepatocellular carcinoma
  • Liver failure
  • Liver surgery
  • Metabolic syndrome
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Obesity
  • Steatosis
  • Survival

ASJC Scopus subject areas

  • Hepatology


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