Abstract
Aims: Up to 30% of HCC are not related to usual risk factors, the majority of these HCC are associated with non-alcoholic fatty liver disease (NAFLD), hepatic manifestations of metabolic syndrome (MS). The purposes of the study were to analyse the clinical features, short-term and long-term outcomes of metabolic syndrome HCC (MS-HCC) compared to alcoholic and viral HCC. Methods: One hundred twenty-four consecutive patients with available etiology data underwent liver resection for HCC from January 2006 to December 2013 in a single HPB tertiary referral center. The clinical, pathological and surgical features, overall survival and disease-free survival data were analysed. Results: Among 124 patients with HCC, 26 patients (20.9%) had MS, 35 patients (28.2%) had alcohol consumption ≥ 60 g/die (alcohol-HCC) and 63 patients (50.9%) presented a HBV and/or HCV infection (viral-HCC). Patients with MS-HCC resulted oldest compare with alcohol and viral HCC with a mean age of 74.83, 70.01 and 68.35 years, respectively, p = 0.029. MS-HCC showed lower rate of underlying cirrhosis (32% vs. 68.6% in alcohol-HCC and 68.3% in viral-HCC, respectively, p = 0.004). Grade 2 or 3 steatosis was significantly more common in MS-HCC (53.9% vs. 11.6% in alcohol-HCC and 5% in viral-HCC). Postoperative mortality was not significantly different between the three groups. The rates of severe complications (Dindo ≥ 3) in MS-HCC, alcohol-HCC and viral-HCC, were 7.7%, 8.6% and 19.0%, respectively, p = 0.034. 5-years overall survival rate of MS-HCC, alcohol-HCC and viral-HCC was 71.7%, 41.5% and 39.2% months, respectively (p = 0.701). 5-years DFS rate was 54.7% in MS-HCC, 28.4% in alcohol-HCC and 19.4% in viral-HCC (p = 0.026). Conclusions: Patients in MS group presented frequently with no underlying liver cirrhosis but with moderate-severe steatosis. DFS was significantly higher in patients with MS-HCC compared with alcohol-HCC and viral-HCC.
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