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Metabolic disorders across hepatocellular carcinoma in Italy
Author(s) -
Morisco Filomena,
Guarino Maria,
Valvano Maria R.,
Auriemma Francesco,
Farinati Fabio,
Giannini Edoardo G.,
Ciccarese Francesca,
Tovoli Francesco,
Rapaccini Gian Ludovico,
Di Marco Maria,
Caturelli Eugenio,
Zoli Marco,
Borzio Franco,
Sacco Rodolfo,
Cabibbo Giuseppe,
Felder Martina,
Benvengù Luisa,
Gasbarrini Antonio,
Svegliati Baroni Gianluca,
Foschi Francesco G.,
Biasini Elisabetta,
Masotto Alberto,
Virdone Roberto,
Marra Fabio,
Caporaso Nicola,
Trevisani Franco
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13877
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , stage (stratigraphy) , diabetes mellitus , metabolic syndrome , liver function , liver cancer , metastasis , etiology , cancer , obesity , endocrinology , biology , paleontology
Background 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. Methods 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. Results 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. Conclusions 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.