Impact of Body Mass Index on Prognosis after Hepatectomy for Patients with Hepato-cellular Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 BIHua-qiang ¹ , LIUHui ² , ZHANGXi ² , MAKuan-sheng ² ,  SHUWei-qun ¹

1. Section of Environmental Health, Faculty of Military Preventive Medicine, The Third Military University, Chongqing 400038, China;
2. Institute of Hepatobiliary Surgery, The First Affiliated Hospital, The Third Military University, Chongqing 400038, China;

Corresponding?author：

SHUWei-qun, Email: xm0630@sina.com

Keywords：

Hepatocellular carcinoma; Body mass index; Obesity; Complications; Disease-free survival

DOI：

10.7507/1007-9424.20160340

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze impact of body mass index (BMI) on postoperative complications and disease-free survival (DFS) after hepatectomy for patients with hepatocellular carcinoma (HCC). Methods In total, 858 patients with HCC underwent hepatectomy were analyzed by retrospective cohort study. Patients were divided into two groups according to BMI:normal group (18.5 kg/m² < BMI < 25.0 kg/m²) and obesity group (BMI≥25.0 kg/m²). The clinical and postoperative follow-up data were collected and statistically analyzed. Results ① Compared with the normal group, the preoperative HBV-DNA loading was significantly lower (P<0.05), albumin was significantly higher (P<0.05), intraopera-tive blood loss was significantly increased (P<0.05), operation time, and the first portal hepatis occlusion time were signifi-cantly prolonged (P<0.05) in the obesity group. The postoperative complications and hospital stay had no significant differences between these two groups (P>0.05). ② The results of univariate analysis showed that the preoperative HBV-DNA≥ 10⁴ U/mL, total bilirubin >21 μmol/L, albumin <35 g/L, grade B of Child-Pugh, intraoperative blood loss >500 mL, and operation time >240 min were associated with the postoperative complications after hepatectomy for patients with HCC (P<0.05). The results of multivariate analysis showed that preoperative total bilirubin >21 μmol/L, albumin <35 g/L, and operation time >240 min were the independent risk factors for postoperative complications (P<0.05). ③ Kaplan-Meier analysis showed that the 3-year DFS in the obesity group was significantly better than that in the normal group (P<0.05). The results of multivariate analysis showed that the major blood vessel tumor thrombi, multicenter tumor, tumor diameter ≥5 cm, and operation time >240 min were the independent risk factors for DFS (P<0.05), while the obesity was the protective factor for DFS (P<0.05). Conclusion For HCC patients who receiving hepatectomy, obesity does not increase risk of postoperative complications, and could increase 3-year DFS. Thus preoperative improvement of nutritional status of patient with HCC has a great significance.

Citation： BIHua-qiang, LIUHui, ZHANGXi, MAKuan-sheng, SHUWei-qun. Impact of Body Mass Index on Prognosis after Hepatectomy for Patients with Hepato-cellular Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1325-1330. doi: 10.7507/1007-9424.20160340 Copy

1.	La Vecchia C, Lucchini F, Franceschi S, et al. Trends in mortality from primary liver cancer in Europe. Eur J Cancer, 2000, 36(7):909-915.
2.	Shibuya K, Yano E. Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972-2001. Int J Epidemiol, 2005, 34(2):397-402.
3.	Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer, 2012, 118(9):2338-2366.
4.	Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma:expert consensus statement. HPB (Oxford), 2010, 12(5):302-310.
5.	No authors listed. Obesity:preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894:i-xii, 1-253.
6.	Polesel J, Zucchetto A, Montella M, et al. The impact of obesity and diabetes mellitus on the risk of hepatocellular carcinoma. Ann Oncol, 2009, 20(2):353-357.
7.	Renehan AG, Soerjomataram I, Tyson M, et al. Incident cancer burden attributable to excess body mass index in 30 European countries. Int J Cancer, 2010, 126(3):692-702.
8.	Regimbeau JM, Colombat M, Mognol P, et al. Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl, 2004, 10(2 Suppl 1):S69-S73.
9.	中華人民共和國衛生部. 原發性肝癌診療規范(2011年版). 臨床肝膽病雜志, 2011, 27(11):1141-1159.
10.	夏鋒, 王曙光, 別平, 等. Pringle法導致的肝臟缺血再灌注損傷對肝癌肝切除患者預后的影響. 中華消化外科雜志, 2009, 8(2):103-106.
11.	倪國華, 張璟, 鄭風田. 中國肥胖流行的現狀與趨勢. 中國食物與營養, 2013, 19(10):70-74.
12.	王嘉譯, 周成, 吳越, 等. 肥胖對肝癌患者肝切除術預后的影響. 肝膽胰外科雜志, 2013, 25(4):275-278.
13.	Wang SH, Yeh SH, Lin WH, et al. Identification of androgen response elements in the enhancer I of hepatitis B virus:a mechanism for sex disparity in chronic hepatitis B. Hepatology, 2009, 50(5):1392-1402.
14.	Chiang CH, Lai JS, Sheu JC, et al. The risky body mass index ranges for significant hepatitis B viral load:A campus-based study. Obes Res Clin Pract, 2012, 6(1):e1-1e90.
15.	Balzan S, Nagarajan G, Farges O, et al. Safety of liver resections in obese and overweight patients. World J Surg, 2010, 34(12):2960-2968.
16.	劉家宏, 盧云. 身體質量指數與肝癌患者術后肝功能預后的關系. 國際外科學雜志, 2011, 38(4):238-240.
17.	Cucchetti A, Cescon M, Ercolani G, et al. Safety of hepatic resection in overweight and obese patients with cirrhosis. Br J Surg, 2011, 98(8):1147-1154.
18.	Tanaka S, Iimuro Y, Hirano T, et al. Safety of hepatic resection for hepatocellular carcinoma in obese patients with cirrhosis. Surg Today, 2013, 43(11):1290-1297.
19.	Saunders JK, Rosman AS, Neihaus D, et al. Safety of hepatic resec-tions in obese veterans. Arch Surg, 2012, 147(4):331-337.
20.	Itoh S, Ikeda Y, Kawanaka H, et al. The effect of overweight status on the short-term and 20-y outcomes after hepatic resection in patients with hepatocellular carcinoma. J Surg Res, 2012, 178(2):640-645.
21.	Utsunomiya T, Okamoto M, Kameyama T, et al. Impact of obesity on the surgical outcome following repeat hepatic resection in Japanese patients with recurrent hepatocellular carcinoma. World J Gastroenterol, 2008, 14(10):1553-1558.
22.	Hotamisligil GS. Inflammation and metabolic disorders. Nature, 2006, 444(7121):860-867.
23.	李敏如, 易述紅, 蔡常潔, 等. 肝癌患者術前HBV DNA定量水平與肝移植術后肝癌復發關系的探討. 中華普通外科雜志, 2010, 25(9):717-719.
24.	劉立國, 吳健雄. 乙肝病毒因素對肝癌肝切除及肝移植術后復發的影響. 中華肝膽外科雜志, 2012, 18(5):398-400.
25.	Huang G, Lai EC, Lau WY, et al. Posthepatectomy HBV reactivation in hepatitis B-related hepatocellular carcinoma influences postoper-ative survival in patients with preoperative low HBV-DNA levels. Ann Surg, 2013, 257(3):490-505.

1. La Vecchia C, Lucchini F, Franceschi S, et al. Trends in mortality from primary liver cancer in Europe. Eur J Cancer, 2000, 36(7):909-915.
2. Shibuya K, Yano E. Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972-2001. Int J Epidemiol, 2005, 34(2):397-402.
3. Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer, 2012, 118(9):2338-2366.
4. Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma:expert consensus statement. HPB (Oxford), 2010, 12(5):302-310.
5. No authors listed. Obesity:preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser, 2000, 894:i-xii, 1-253.
6. Polesel J, Zucchetto A, Montella M, et al. The impact of obesity and diabetes mellitus on the risk of hepatocellular carcinoma. Ann Oncol, 2009, 20(2):353-357.
7. Renehan AG, Soerjomataram I, Tyson M, et al. Incident cancer burden attributable to excess body mass index in 30 European countries. Int J Cancer, 2010, 126(3):692-702.
8. Regimbeau JM, Colombat M, Mognol P, et al. Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl, 2004, 10(2 Suppl 1):S69-S73.
9. 中華人民共和國衛生部. 原發性肝癌診療規范(2011年版). 臨床肝膽病雜志, 2011, 27(11):1141-1159.
10. 夏鋒, 王曙光, 別平, 等. Pringle法導致的肝臟缺血再灌注損傷對肝癌肝切除患者預后的影響. 中華消化外科雜志, 2009, 8(2):103-106.
11. 倪國華, 張璟, 鄭風田. 中國肥胖流行的現狀與趨勢. 中國食物與營養, 2013, 19(10):70-74.
12. 王嘉譯, 周成, 吳越, 等. 肥胖對肝癌患者肝切除術預后的影響. 肝膽胰外科雜志, 2013, 25(4):275-278.
13. Wang SH, Yeh SH, Lin WH, et al. Identification of androgen response elements in the enhancer I of hepatitis B virus:a mechanism for sex disparity in chronic hepatitis B. Hepatology, 2009, 50(5):1392-1402.
14. Chiang CH, Lai JS, Sheu JC, et al. The risky body mass index ranges for significant hepatitis B viral load:A campus-based study. Obes Res Clin Pract, 2012, 6(1):e1-1e90.
15. Balzan S, Nagarajan G, Farges O, et al. Safety of liver resections in obese and overweight patients. World J Surg, 2010, 34(12):2960-2968.
16. 劉家宏, 盧云. 身體質量指數與肝癌患者術后肝功能預后的關系. 國際外科學雜志, 2011, 38(4):238-240.
17. Cucchetti A, Cescon M, Ercolani G, et al. Safety of hepatic resection in overweight and obese patients with cirrhosis. Br J Surg, 2011, 98(8):1147-1154.
18. Tanaka S, Iimuro Y, Hirano T, et al. Safety of hepatic resection for hepatocellular carcinoma in obese patients with cirrhosis. Surg Today, 2013, 43(11):1290-1297.
19. Saunders JK, Rosman AS, Neihaus D, et al. Safety of hepatic resec-tions in obese veterans. Arch Surg, 2012, 147(4):331-337.
20. Itoh S, Ikeda Y, Kawanaka H, et al. The effect of overweight status on the short-term and 20-y outcomes after hepatic resection in patients with hepatocellular carcinoma. J Surg Res, 2012, 178(2):640-645.
21. Utsunomiya T, Okamoto M, Kameyama T, et al. Impact of obesity on the surgical outcome following repeat hepatic resection in Japanese patients with recurrent hepatocellular carcinoma. World J Gastroenterol, 2008, 14(10):1553-1558.
22. Hotamisligil GS. Inflammation and metabolic disorders. Nature, 2006, 444(7121):860-867.
23. 李敏如, 易述紅, 蔡常潔, 等. 肝癌患者術前HBV DNA定量水平與肝移植術后肝癌復發關系的探討. 中華普通外科雜志, 2010, 25(9):717-719.
24. 劉立國, 吳健雄. 乙肝病毒因素對肝癌肝切除及肝移植術后復發的影響. 中華肝膽外科雜志, 2012, 18(5):398-400.
25. Huang G, Lai EC, Lau WY, et al. Posthepatectomy HBV reactivation in hepatitis B-related hepatocellular carcinoma influences postoper-ative survival in patients with preoperative low HBV-DNA levels. Ann Surg, 2013, 257(3):490-505.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Impact of Body Mass Index on Prognosis after Hepatectomy for Patients with Hepato-cellular Carcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content