Objective To explore the impact of metabolic dysfunction-associated fatty liver disease (MAFLD) on the achievement of textbook outcome (TO) of patients with hepatocellular carcinoma (HCC) after hepatectomy, and to identify the risk factors affecting the achievement of TO of HCC patients after hepatectomy. MethodsThe data of patients with Barcelona Clinic Liver Cancer stage 0/A HCC who received primary hepatectomy at our center from 2014 to 2022 were retrospectively reviewed. Patients were divided into the MAFLD group and the non-MAFLD group based on whether coexisting MAFLD. Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. The achievement of TO and its seven items before and after PSM was compared between the two groups. Logistic regression was applied to analyze the independent risk factors affecting the achievement of TO based the total population. ResultsA total of 2 301 patients were included in this study. After PSM, 299 patients in each group were included in the analysis. After PSM, the TO achievement rate in the MAFLD group was 63.5% (190/299), which was significantly poor than that in the non-MAFLD group [71.6% (214/299)], χ2=4.395, P=0.036. Among the seven items of TO, the proportion of prolonged hospital stay in the MAFLD group was 29.4% (88/299), while that in the non-MAFLD group was 21.1% (63/299), the difference was statistically significant (χ2=5.537, P=0.019). The rates of ≥ Clavien-Dindo grade 3 complications within 30 days, perioperative blood transfusion, mortality within 90 days after surgery, readmission within 30 days after discharge, conversion from laparoscopic to open hepatectomy, and R0 resection rate were similar between the two groups (P>0.05). Multivariate logistic regression analysis confirmed that tumor diameter>5 cm [OR=1.539, 95%CI (1.264, 1.874), P<0.001], albumin-bilirubin grade 2 [OR=1.941, 95%CI (1.588, 2.372), P<0.001], FIB-4>3.25 [OR=1.545, 95%CI (1.273, 1.875), P<0.001], Barcelona Clinic Liver Cancer stage A [OR=1.696, 95%CI (1.132, 2.542), P=0.010], major hepatectomy [OR=1.431, 95%CI (1.178, 1.738), P<0.001], and MAFLD [OR=1.549, 95%CI (1.188, 2.019), P=0.001] were independent risk factors affecting the achievement of TO, but laparoscopic hepatectomy [OR=0.629, 95%CI (0.503, 0.786), P<0.001] was a protective factor for achieving TO. ConclusionHCC patients coexisting MAFLD have a higher incidence of prolonged hospital stay after hepatectomy and are less likely to achieve TO.
Objective To study the effect of alpha fetoprotein-tumor burden score (ATS) on the long-term prognosis of hepatocellular carcinoma (HCC) after resection. MethodsThe data of 2 907 patients with HCC who underwent first hepatectomy from West China Hospital of Sichuan University, West China Ziyang Hospital/Ziyang Central Hospital, The First People’s Hospital of Neijiang, West China Yibin Hospital/the Second People’s Hospital of Yibin, and the Affiliated Hospital of Chengdu University between 2015 and 2022, were retrospectively analyzed. The X-tile software was used to calculate the optimal truncation of the ATS score. Cox proportional hazard regression model was used to explore risk factors affecting postoperative recurrence-free survival (RFS) and overall survival (OS) in HCC patients, respectively. ResultsAll patients were followed-up with a median of 37 months (1–90 months), 1 364 cases (46.9%, the recurrence time was 1–89 months after surgery) of them experienced recurrence and 847 cases (29.1%) died (the death time was 1–88 months after surgery). The 1-, 2- and 3-year OS rates were 89.3%, 81.4% and 75.9%, respectively. The 1-, 2- and 3-year RFS rates were 76.0%, 64.3% and 57.2%, respectively. The 5-year RFS rate of HCC patients with low-, medium-, and high-ATS scores were 56.4%, 45.0% and 27.2%, respectively, and patients with low ATS score had better RFS (χ2=264.747, P<0.001). The 5-year OS rates of HCC patients with low-, medium-, and high-ATS scores were 78.0%, 59.8% and 38.8%, respectively, and patients with low-ATS score had better OS (χ2=372.685, P<0.001). Multivariate Cox proportional hazard regression model suggested that, in condition of adjusting other factors, medium-ATS score [RR=1.375, 95%CI (1.209, 1.564), P<0.001] and high-ATS score [RR=2.048, 95%CI (1.764, 2.377), P<0.001] were risk factors for postoperative RFS; the medium-ATS score [RR=1.779, 95%CI (1.499, 2.112), P<0.001] and high ATS score [RR=2.676, 95%CI (2.211, 3.239), P<0.001] were also risk factors affecting postoperative OS. ConclusionATS score can predict the prognosis of HCC patients after resection, patients with high ATS score had a higher incidence of postoperative recurrence and mortality.