Impact of Individual Components of the Metabolic Syndrome on the Outcome of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib

Abstract

Background/Aim: Individual components of the metabolic syndrome (MS) such as obesity or diabetes mellitus impair the prognosis of patients with hepatocellular carcinoma (HCC) following curative treatment approaches or transarterial therapies. The aim of this retrospective study was to assess the impact of these factors on the overall survival (OS) of patients with advanced HCC treated with sorafenib. Methods: Univariate and multivariate analyses were performed to assess the impact of individual components of the MS on the OS of 152 consecutive patients with advanced HCC treated with sorafenib. Results: The presence of overweight/obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and of the MS itself did not impair the median OS. Multivariate analysis showed that Eastern Cooperative Oncology Group Performance Status ≥1 (hazards ratio [HR] 2.03), presence of macrovascular invasion (HR 1.71), Child-Pugh score B/C (HR 2.19), tumor grading G3 (HR 2.17), no prior HCC treatment (HR 2.34), and the presence of 2 or more out of 5 individual components of the MS (HR 0.65) were independent prognostic factors regarding the median OS. Conclusions: Our investigations do not confirm a negative prognostic role of individual components of the MS or the MS itself for patients with advanced HCC treated with sorafenib.

Metabolic disorders across hepatocellular carcinoma in Italy

“…Finally, the multivariate analysis selected BCLC stage as the only factor related to OS in Group 1 and 2, whereas, in Group 3, the prognosis was dictated by HCC morphology, portal vein thrombosis and presence of metastasis. Taken together, these results indicate that metabolic disorders per se do not play a crucial role in survival, despite their effects on clinical picture of HCC, as recently reported by Labenz et al in the subgroup of HCC patients treated with sorafenib.…”

Metabolic Disorders across Hepatocellular Carcinoma in Italy

“…Finally, the multivariate analysis selected BCLC stage as the only factor related to OS in Group 1 and 2, whereas, in Group 3, the prognosis was dictated by HCC morphology, portal vein thrombosis and presence of metastasis. Taken together, these results indicate that metabolic disorders per se do not play a crucial role in survival, despite their effects on clinical picture of HCC, as recently reported by Labenz et al in the subgroup of HCC patients treated with sorafenib [44].…”

Understanding the Role of Metabolic Syndrome as a Risk Factor for Hepatocellular Carcinoma

“…Therefore, patients with non-cirrhotic HCC are not commonly eligible for liver transplantation, as they do not meet the Milan criteria; moreover, they are less frequently diagnosed during tumor surveillance, further decreasing the likelihood of liver transplantation. 49,61 Patients with NAFLD-HCC who undergo liver resection or orthotopic liver transplantation have worse perioperative and short-term cardiovascular, respiratory, and infectious complications linked to obesity and diabetes. However, their overall long-term survival is comparable with HCC with other etiologies.…”

“…However, their overall long-term survival is comparable with HCC with other etiologies. 49,61 Careful consideration is also essential for nonsurgical treatments. Although evidence supporting treatment selection is frequently lacking, as these patients tend to be poorly represented in clinical trials, locoregional therapies such as percutaneous ablation and transarterial chemoembolization may be less well-tolerated and less effective in patients with NAFLD with obesity or diabetes.…”

“…Therefore, patients with non-cirrhotic HCC are not commonly eligible for liver transplantation, as they do not meet the Milan criteria; moreover, they are less frequently diagnosed during tumor surveillance, further decreasing the likelihood of liver transplantation. 49 , 61 …”