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. 2024 May 1;19(1):21.
doi: 10.1186/s13027-024-00575-6.

Prevalence of metabolic syndrome among patients with hepatocellular carcinoma of different etiologies: a retrospective study

Da-Long Yang #  1 , Shao-Ping Liu #  2 , Hong-Liang Wang #  3 , Jian-Rong Li #  1 , Jia-Yong Su  1 , Min-Jun Li  1 , Yu-Xian Teng  1 , Zhu-Jian Deng  1 , Zhong-Hai Li  1 , Jian-Li Huang  1 , Ping-Ping Guo  1 , Liang Ma  1 , Zhen-Zhen Li  4 , Jian-Hong Zhong  5   6   7
Affiliations

Prevalence of metabolic syndrome among patients with hepatocellular carcinoma of different etiologies: a retrospective study

Da-Long Yang et al. Infect Agent Cancer. .

Abstract

Aims: This study compared the prevalences of metabolic syndrome and of cardiac or kidney comorbidities among patients with hepatocellular carcinoma (HCC) associated with metabolic dysfunction-related fatty liver disease (MAFLD), chronic infection with hepatitis B or C virus (HBV or HCV), or the combination of MAFLD and chronic HBV infection.

Methods: Medical records were retrospectively analyzed for patients with HCC who underwent hepatectomy between March 2013 and March 2023. Patients with HCC of different etiologies were compared in terms of their clinicodemographic characteristics and laboratory data before surgery.

Results: Of the 2422 patients, 1,822 (75.2%) were chronically infected with HBV without MAFLD and HCV, 415 (17.2%) had concurrent MAFLD and chronic HBV infection but no HCV infection, 121 (5.0%) had MAFLD without hepatitis virus infection, and 64 (2.6%) were chronically infected with HCV in the presence or absence of MAFLD and HBV infection. Compared to patients chronically infected with HBV without MAFLD and HCV, those with MAFLD but no hepatitis virus infection showed significantly lower prevalence of cirrhosis, ascites, portal hypertension, alpha-fetoprotein concentration ≥ 400 ng/mL, tumor size > 5 cm, multinodular tumors and microvascular invasion. Conversely, they showed significantly higher prevalence of metabolic syndrome, hypertension, type 2 diabetes, abdominal obesity, history of cardiovascular disease, T-wave alterations, hypertriglyceridemia and hyperuricemia, as well as higher risk of arteriosclerotic cardiovascular disease. Compared to patients with MAFLD but no hepatitis virus infection, those with concurrent MAFLD and chronic infection with HBV showed significantly higher prevalence of cirrhosis, ascites and portal hypertension, but significantly lower prevalence of hypertension and history of cardiovascular disease. Compared to patients with other etiologies, those chronically infected with HCV in the presence or absence of MAFLD and HBV infection, showed significantly higher prevalence of cirrhosis, portal hypertension, ascites, and esophagogastric varices.

Conclusion: Patients with HCC associated with MAFLD tend to have a background of less severe liver disease than those with HCC of other etiologies, but they may be more likely to suffer metabolic syndrome or comorbidities affecting the heart or kidneys.

Keywords: Chronic hepatitis B; Hepatocellular carcinoma; Metabolic dysfunction-related fatty liver disease; Metabolic syndrome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection and stratification. HCC, hepatocellular carcinoma; ICC, intrahepatic cholangiocarcinoma; CHB, chronic infection with hepatitis B virus; HCV, chronic infection with hepatitis C virus; MAFLD, metabolic dysfunction-associated fatty liver disease
Fig. 2
Fig. 2
Prevalence of (A) metabolic syndrome, (B) hypertension, (C) type 2 diabetes, (D) overweight and (E) hypertriglyceridemia. among patients with hepatocellular carcinoma associated with chronic HBV infection but not MAFLD or chronic HCV infection (“CHB”); HCC associated with MAFLD but not chronic infection with HBV or HCV (“MAFLD”); HCC associated with concurrent MAFLD and chronic HBV infection, but not chronic HCV infection (“CHB/MAFLD”); or HCC associated with chronic HCV infection in the presence or absence of chronic HBV infection and the presence or absence of MAFLD (“HCV”). HBV, hepatitis B virus; HCV, hepatitis C virus; MAFLD, metabolic dysfunction-associated fatty liver disease
Fig. 3
Fig. 3
Prevalence of (A) history of cardiovascular disease (CVD), (B) high risk of ASCVD, (C) premature atrial beats, (D) T-wave alterations, and (E) abnormal levels of myocardial enzymes. among patients with hepatocellular carcinoma associated with chronic HBV infection but not MAFLD or chronic HCV infection (“CHB”); HCC associated with MAFLD but not chronic infection with HBV or HCV (“MAFLD”); HCC associated with concurrent MAFLD and chronic HBV infection, but not chronic HCV infection (“CHB/MAFLD”); or HCC associated with chronic HCV infection in the presence or absence of chronic HBV infection and the presence or absence of MAFLD (“HCV”). HBV, hepatitis B virus; HCV, hepatitis C virus; MAFLD, metabolic dysfunction-associated fatty liver disease; ASCVD, arteriosclerotic cardiovascular disease
Fig. 4
Fig. 4
Prevalence of (A) chronic kidney disease (CKD), and (B) hyperuricemia. among patients with hepatocellular carcinoma associated with chronic HBV infection but not MAFLD or chronic HCV infection (“CHB”); HCC associated with MAFLD but not chronic infection with HBV or HCV (“MAFLD”); HCC associated with concurrent MAFLD and chronic HBV infection, but not chronic HCV infection (“CHB/MAFLD”); or HCC associated with chronic HCV infection in the presence or absence of chronic HBV infection and the presence or absence of MAFLD (“HCV”). HBV, hepatitis B virus; HCV, hepatitis C virus; MAFLD, metabolic dysfunction-associated fatty liver disease
Fig. 5
Fig. 5
Prevalence of (A) cirrhosis, (B) portal hypertension, (C) ascites, and (D) esophagogastric varices. among patients with hepatocellular carcinoma associated with chronic HBV infection but not MAFLD or chronic HCV infection (“CHB”); HCC associated with MAFLD but not chronic infection with HBV or HCV (“MAFLD”); HCC associated with concurrent MAFLD and chronic HBV infection, but not chronic HCV infection (“CHB/MAFLD”); or HCC associated with chronic HCV infection in the presence or absence of chronic HBV infection and the presence or absence of MAFLD (“HCV”). HBV, hepatitis B virus; HCV, hepatitis C virus; MAFLD, metabolic dysfunction-associated fatty liver disease
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