A Model to Predict Outcomes Following Liver Resection for Hepatocellular Carcinoma on Metabolic Syndrome: A Western Perspective on a Rising Disease

Introduction: Liver resection for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS) is associated with increased postoperative risks. The aim of this study was to review a large Western database and investigate predictive factors of morbidity after surgery and long-term survival. Methods: Data was randomly split (2/3) to build and internally validate prediction models. The least absolute shrinkage and selection operator (LASSO) analysis was applied to identify the best predictors among prespecified variables. Results: 669 patients were included from 20 centres between 2001 and 2021. Postoperative mortality and morbidity were 3.2% and 35.4% respectively. Age, Meld score, blood loss, comorbidities, previous supramesocolic surgery, type of approach and type of hepatectomy were associated with postoperative morbidity and included in the model. The AUC from the validation of the model was 0.67 (95%CI 0.61-0.75). 5y overall survival (OS) was 53%. BMI, portal hypertension, previous HCC treatment, size of lesion, type of approach, type of hepatectomy and microvascular invasion were associated with OS. 5y Disease-free survival (DFS) was 51%. Portal hypertension, type of approach, microvascular invasion and NAFLD activity score were associated with DFS. Conclusions: Liver resection for HCC on MS is associated with good postoperative outcomes and safe survivals in experienced centres. Patient and disease features, along with surgical characteristics, are associated with short- and long-term outcomes and can be used to select patients for surgery.