Impact of preoperative weight status on long-term prognosis in patients undergoing liver resection of hepatocellular carcinoma: a multicenter large cohort study

Abstract

Introduction: Overweight has been identified as a significant risk associated with long-term prognosis after liver resection of hepatocellular carcinoma (HCC). Although underweight is not unusual in HCC patients, its association with long-term outcomes after resection of HCC remains unclear. Therefore, we investigated the relationship between different preoperative weight status and long-term outcomes in patients undergoing HCC resection. Methods: Patients treated with curative liver resection of HCC at six Chinese institutions between 2001 and 2013 were divided into 3 groups: underweight group (BMI < 18.5), normal-weight group (BMI 18.5 ∼ 25.0) and overweight group (BMI > 25.0). Baseline characteristics and clinical variables were collected and compared. Univariate and multivariate Cox-regression analyses were performed to identify risk factors of overall survival (OS) and recurrence-free survival (RFS). Results: Of all 1,524 patients, there were 891 normal-weight, 107 underweight, and 526 overweight. Underweight and overweight patients had significantly poorer OS and RFS than normal-weight patients (all P < 0.01). Multivariate Cox-regression analysis identified that underweight and overweight were significantly associated with decreased OS (HR 1.217, 95% CI 1.19-1.56, P = 0.02, and HR 1.59, 95% CI 1.36-1.81, P < 0.01), and RFS (HR 1.30, 95% CI: 1.19-1.53, P < 0.01, and HR 1.34, 95% CI 1.17-1.54, P < 0.01). Conclusion: Apart from overweight, underweight was also significantly associated with decreased OS and RFS in patients undergoing liver resection for HCC.