Metabolic Syndrome Leads to Worse Outcomes For Patients With HBV-Related HCC

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Concurrent metabolic syndrome was independently linked to a worse overall and recurrence-free survival rates.

Metabolic syndrome is connected to a worse overall survival for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

A team, led by Ming-Da Wang, MD, Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), identified the association of concurrent metabolic syndrome with long-term prognosis following liver resection for patients with HBV-related HCC.


While HBV infections are the main cause of HCC worldwide, metabolic syndrome is also an important and significant risk factor for HCC.

In the multi-center, database study, the investigators identified patients with HBV who underwent curative resection for HCC in China between 2010-2020 and compared long-term oncological prognosis, including overall survival, recurrence-free survival, and early and late recurrences between patients with metabolic syndrome and without metabolic syndrome.

Overall, there were 1753 patients included in the study, 9.3% (n = 163) of which had concurrent metabolic syndrome.

Outcomes With Metabolic Syndrome

Patients with metabolic syndrome had a worse 5-year overall survival compared to patients without metabolic syndrome (47.5% vs. 61.0%; P = 0.010). They also had worse recurrence-free survival rates (28.3% vs. 44.2%; P = 0.003) and a higher 5-year overall recurrence rate (67.3% vs. 53.3%; P = 0.024).

After conducting a multivariate analysis, the investigators found concurrent metabolic syndrome was independently linked to a worse overall survival (HR, 1.300; 95% CI, 1.018-1.660; P = 0.036) and recurrence-free survival rates (HR, 1.314; 95% CI, 1.062-1.627; P = 0.012).

There were also increased rates of late recurrence (HR, 1.470; 95% CI, 1.004-2.151; P = 0.047).

“In HBV-infected patients with HCC, concurrent metabolic syndrome was associated with poorer postoperative long-term oncologic survival outcomes,” the authors wrote. “These results suggested that patients with metabolic syndrome should undergo enhanced surveillance for tumor recurrence even after 2 years of surgery to early detect late HCC recurrence. Whether improving metabolic syndrome can reduce postoperative recurrence of HCC deserves further exploration.”


Recently, a team, led by Nobuhiro Hattori, Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, identified the risk factors linked to liver-related and non-liver-related mortality in patients with hepatitis C virus (HCV) following sustained virologic response to direct-acting antiviral agents in HCC and diabetes mellitus.

The results show a cumulative liver-related or non-liver-related mortality rate of 0.00 or 1.29% at year 1, compared to 2.87 or 3.60% at year 3 and 5.10 or 9.46% at year 5.

For liver-related deaths, 90% (n = 9) were from liver cancer, while the most common cause of non-liver-related deaths was malignancy.

After conducting a multivariate analysis using the Cox proportional hazard model, the investigators found diabetes mellitus (HR, 13.1; 95% CI, 2.81–61.3) and a history of hepatocellular carcinoma (HR, 12.8; 95% CI, 2.76–59.2), independently predicted liver-related death. There were no variables linked to non-liver-related death.

The study, “Association of Concurrent Metabolic Syndrome with Long-term Oncological Prognosis Following Liver Resection for Hepatocellular Carcinoma Among Patients with Chronic Hepatitis B Virus Infection: A Multicenter Study of 1753 Patients,” was published online in the Annals of Surgical Oncology.