Metabolic burden but not metabolic dysfunction-associated steatotic liver disease affects the prognosis of patients with hepatocellular carcinoma after hepatectomy: a retrospective cohort study.

BACKGROUND: The impact of concurrent metabolic dysfunction associated steatotic liver disease (MASLD) on the prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy is controversial. Moreover, there is little information regarding the effect of metabolic burden on HCC patients. This study aimed to identify the influence of concurrent MASLD and metabolic burden on the prognosis of HCC patients after hepatectomy. METHODS: Data of HCC patients who received hepatectomy between 2013 and 2018 at West China Hospital were retrospectively reviewed. Metabolic burden was defined as the cumulative number of metabolic abnormalities including overweight/obesity, blood hypertension, prediabetes/diabetes and dyslipidemia [including hypertriglyceridemia and/or low high-density lipoprotein cholesterol (HDL-C)]. Logistic regression and Cox regression analyses were carried out to identify the independent risk factors associated with severe postoperative complications and oncological outcomes respectively. RESULTS: After propensity score matching (PSM), severe postoperative complication rates were 5.4% and 6.9% in MASLD and non-MASLD patients, respectively (P=0.54). Moreover, both the 5-year recurrence-free survival (RFS) and overall survival (OS) rates of MASLD and non-MASLD patients were similar (RFS: 44.7% vs. 40.2%, P=0.33; OS: 61.2% vs. 60.7%; P=0.69). Multivariate analyses revealed that metabolic burden was independently associated with severe postoperative complications, RFS and OS, whereas MASLD was not. Severe postoperative complication rates in patients with metabolic burden 0, 1-2 and 3-4 were 2.8%, 5.7%, and 9.4%, respectively (Pfor trend=0.007). The 5-year RFS rates were 50.5%, 38.4%, and 29.6%, respectively (Pfor trend=0.04), while the 5-year OS rates were 65.2%, 56.2%, and 43.7%, respectively (Pfor trend=0.001), in patients with metabolic burden 0, 1-2 and 3-4. CONCLUSIONS: The metabolic burden, but not MASLD, adversely affects the prognosis of HCC patients after hepatectomy. The more metabolic burden patients have, the more likely they are to have a poor prognosis after hepatectomy.