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.	中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 临床肝胆病杂志, 2011, 27(11):1141-1159.
10.	夏锋, 王曙光, 别平, 等. Pringle法导致的肝脏缺血再灌注损伤对肝癌肝切除患者预后的影响. 中华消化外科杂志, 2009, 8(2):103-106.
11.	倪国华, 张璟, 郑风田. 中国肥胖流行的现状与趋势. 中国食物与营养, 2013, 19(10):70-74.
12.	王嘉译, 周成, 吴越, 等. 肥胖对肝癌患者肝切除术预后的影响. 肝胆胰外科杂志, 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.	刘家宏, 卢云. 身体质量指数与肝癌患者术后肝功能预后的关系. 国际外科学杂志, 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, 易述红, 蔡常洁, 等. 肝癌患者术前HBV DNA定量水平与肝移植术后肝癌复发关系的探讨. 中华普通外科杂志, 2010, 25(9):717-719.
24.	刘立国, 吴健雄. 乙肝病毒因素对肝癌肝切除及肝移植术后复发的影响. 中华肝胆外科杂志, 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. 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 临床肝胆病杂志, 2011, 27(11):1141-1159.
10. 夏锋, 王曙光, 别平, 等. Pringle法导致的肝脏缺血再灌注损伤对肝癌肝切除患者预后的影响. 中华消化外科杂志, 2009, 8(2):103-106.
11. 倪国华, 张璟, 郑风田. 中国肥胖流行的现状与趋势. 中国食物与营养, 2013, 19(10):70-74.
12. 王嘉译, 周成, 吴越, 等. 肥胖对肝癌患者肝切除术预后的影响. 肝胆胰外科杂志, 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. 刘家宏, 卢云. 身体质量指数与肝癌患者术后肝功能预后的关系. 国际外科学杂志, 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, 易述红, 蔡常洁, 等. 肝癌患者术前HBV DNA定量水平与肝移植术后肝癌复发关系的探讨. 中华普通外科杂志, 2010, 25(9):717-719.
24. 刘立国, 吴健雄. 乙肝病毒因素对肝癌肝切除及肝移植术后复发的影响. 中华肝胆外科杂志, 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