Abstract
Metabolic disorders are well-known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its aetiology. We analysed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analysed: BMI, diabetes, arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia. According to these features, patients were divided into 3 groups: 0-1, 2 and 3-5 metabolic features. As compared with patients with 0-1 metabolic features, patients with 3-5 features showed lower percentage of HCC diagnosis on surveillance (P=.021), larger tumours (P=.038), better liver function (higher percentage of Child-Pugh class A [P=.007] and MELD<10 [P=.003]), higher percentage of metastasis (P=.024) and lower percentage of portal vein thrombosis (P=.010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to loco-regional therapies for BCLC stage B patients with 3-5 features (P=.012). Overall survival and survival according to BCLC stage and/or treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (P=.046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of lead-time adjusted survival. Our "real world" study suggests that metabolic disorders shape the clinical presentation of HCC but do not seem to play a major role in setting patient survival.
Highlights
The incidence of hepatocellular carcinoma (HCC) is increasing in Europe [1]
For the purpose of this study, we analyzed the data of 1950 cirrhotic HCC patients, consecutively examined and managed during 5 years, from January 2009 to December 2014, in order to analyze the updated managing of HCC and to avoid any interference related to the use of the new direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment
Viral etiology accounted for the majority (58%) of cases, followed by metabolic etiology (23%) and alcoholic etiology (19%)
Summary
The incidence of hepatocellular carcinoma (HCC) is increasing in Europe [1]. Chronic infection with hepatitis C virus (HCV), hepatitis B virus and excessive alcohol consumption are the major risk factors in industrialized countries [2]. The relative risk of HCC is higher than that of other cancer [13], and the cumulative incidence of HCC in diabetic patients is three times higher than in non diabetic patients [7]. Both obesity and diabetes are components of the metabolic syndrome (MS) [14,15], characterized by the presence of central obesity, dyslipidemia, diabetes, arterial hypertension [16]. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its etiology
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