Pre-operative BMI and risk of HCC recurrence in liver recipients

Obesity is a well-documented and alterable risk factor for the development of hepatocellular car-cinoma (HCC) in the general population. The applicability of these findings to liver recipients is uncertain, and results of available data have not been unanimous. The objectives of the current study was to investigate the association between the pre-operative body mass index (BMI) and oncological outcomes in liver recipients with HCC in a native liver. Methods: This observational retrospective study enrolled all patients with histologically confirmed HCC who underwent liver transplantation from a deceased donor in our centre between 2008 and 2018. Results: Overall, 83 patients were enrolled and were subsequently stratified according to their pre-operative BMI into 3 Groups: patients with normal body weight (n=53), patients with overweight (n=23), patients with obesity (n=7). Overall tumour recurrence was 12%. Dry-weight-adjusted BMI failed to predict the 5-year recurrence-free survival (p=0.55), risk of tumour recurrence (p=0.314) and overall 5-year survival (p=0.19) in liver recipients. Tumour recurrence constituted the sole determinant of overall 5-year survival (HR: 13.961; 95 CI 3.442-56.6; p<0.001), whereas 5-year recurrence-free survival was independently associated with fulfilment of the Milan criteria (p=0.46), a lack of microvascular invasion (p=0.01) and a low AFP level at baseline (p=0.03). Conclusions: BMI was proven to be an unreliable surrogate measure of obesity for predicting oncological outcomes among liver transplant recipients. Other obesity indices should be referenced in order to assess cancer-related prognosis more accurately in patients with chronic liver disease.

肥胖是普通人群中肝细胞癌（hepatocellular carcinoma, HCC）发生的一项有据可查且可干预的危险因素。但上述研究结论在肝移植受者中的适用性尚不明确，现有相关数据的研究结果亦未达成统一。本研究旨在探讨自身原发肝脏罹患肝细胞癌的肝移植受者中，术前体质量指数（body mass index, BMI）与肿瘤学预后的关联。
方法：本项观察性回顾性研究纳入了2008年至2018年间，本中心所有接受尸体供肝移植、经组织学确诊为肝细胞癌的患者。
结果：最终共纳入83例患者，随后根据术前体质量指数将其分为3组：体质量正常组（n=53）、超重组（n=23）及肥胖组（n=7）。整体肿瘤复发率为12%。干体重校正后的体质量指数无法预测肝移植受者的5年无复发生存率（p=0.55）、肿瘤复发风险（p=0.314）及整体5年生存率（p=0.19）。肿瘤复发是影响整体5年生存率的唯一独立危险因素（风险比（hazard ratio, HR）=13.961；95%置信区间（confidence interval, CI）：3.442~56.6；p<0.001）；而5年无复发生存率则与满足米兰标准（Milan criteria, p=0.46）、无微血管侵犯（microvascular invasion, p=0.01）及基线甲胎蛋白（alpha-fetoprotein, AFP）水平较低（p=0.03）独立相关。
结论：本研究证实，体质量指数并非预测肝移植受者肿瘤学预后的可靠肥胖替代指标。针对慢性肝病患者，应采用其他肥胖评估指标以更精准地评估其肿瘤相关预后。