HPB : the official journal of the International Hepato Pancreato Biliary Association · 2025
Unraveling the obesity paradox in hepatocellular carcinoma: relative role of elevated body mass index on detrimental effects of postoperative complications.
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Akabane Miho, Kawashima Jun, Altaf Abdullah, Woldesenbet Selamawit, Cauchy François, Aucejo Federico, Popescu Irinel, Kitago Minoru, Martel Guillaume, Ratti Francesca, Aldrighetti Luca, Poultsides George A, Imaoka Yuki, Ruzzenente Andrea, Endo Itaru, Gleisner Ana, Marques Hugo P, Oliveira Sara, Balaia Jorge, Lam Vincent, Hugh Tom, Bhimani Nazim, Shen Feng, Pawlik Timothy M
Аннотация
BACKGROUND: The "obesity paradox" suggests higher body mass index (BMI) may correlate with better long-term outcomes in cancers. The impact of BMI on hepatocellular carcinoma (HCC) resection, regarding postoperative complications, remains unclear. We examined the interplay between BMI and complications on recurrence-free survival (RFS) among patients undergoing HCC resection.
METHODS: Patients undergoing hepatectomy for HCC (2000-2023) were identified from an international database. Kaplan-Meier and Cox analyses assessed the protective impact of high BMI on RFS, considering interactions with complications.
RESULTS: Among 1,588 patients (median BMI: 25.2 kg/m²; BMI > 25.0:793, BMI ≤ 25.0:795), 560 (35.3%) experienced complications. BMI > 25.0kg/m² was linked to better 5-year RFS than BMI ≤ 25.0kg/m² (50.3% vs 45.4%; p = 0.006). Patients without complications had better 5-year RFS than those with complications (51.7% vs 40.7%; p < 0.001). Among patients without complications, RFS was comparable among BMI groups (52.9% vs 50.6%; p = 0.215), but among patients with complications BMI > 25.0kg/m² was associated with better RFS (45.6% vs 34.2%; p < 0.001). Patients with complications and BMI > 25.0 kg/m² had RFS comparable to patients without complications, regardless of BMI. Multivariable analysis identified complications (HR:1.31 [1.08-1.60]; p = 0.007) as a predictor of worse RFS, while BMI > 25.0 kg/m² (HR: 0.79 [0.68-0.96]; p = 0.020) was protective. Spline analysis demonstrated recurrence risk declined with increasing BMI among patients with complications, crossing below 1 around 25.0kg/m². Stratifying the complication cohort (BMI ≤ 25.0/25.0-30.0/>30.0 kg/m²) demonstrated dose-dependent RFS improvement (p = 0.005).
CONCLUSION: High BMI correlated with better RFS following HCC resection among patients with complications. Concerns about complications should not deter surgery among high-BMI patients.
METHODS: Patients undergoing hepatectomy for HCC (2000-2023) were identified from an international database. Kaplan-Meier and Cox analyses assessed the protective impact of high BMI on RFS, considering interactions with complications.
RESULTS: Among 1,588 patients (median BMI: 25.2 kg/m²; BMI > 25.0:793, BMI ≤ 25.0:795), 560 (35.3%) experienced complications. BMI > 25.0kg/m² was linked to better 5-year RFS than BMI ≤ 25.0kg/m² (50.3% vs 45.4%; p = 0.006). Patients without complications had better 5-year RFS than those with complications (51.7% vs 40.7%; p < 0.001). Among patients without complications, RFS was comparable among BMI groups (52.9% vs 50.6%; p = 0.215), but among patients with complications BMI > 25.0kg/m² was associated with better RFS (45.6% vs 34.2%; p < 0.001). Patients with complications and BMI > 25.0 kg/m² had RFS comparable to patients without complications, regardless of BMI. Multivariable analysis identified complications (HR:1.31 [1.08-1.60]; p = 0.007) as a predictor of worse RFS, while BMI > 25.0 kg/m² (HR: 0.79 [0.68-0.96]; p = 0.020) was protective. Spline analysis demonstrated recurrence risk declined with increasing BMI among patients with complications, crossing below 1 around 25.0kg/m². Stratifying the complication cohort (BMI ≤ 25.0/25.0-30.0/>30.0 kg/m²) demonstrated dose-dependent RFS improvement (p = 0.005).
CONCLUSION: High BMI correlated with better RFS following HCC resection among patients with complications. Concerns about complications should not deter surgery among high-BMI patients.
Предметные рубрики MeSH
HumansCarcinoma, HepatocellularLiver NeoplasmsBody Mass IndexMaleFemaleHepatectomyMiddle AgedObesityRisk FactorsPostoperative ComplicationsAgedTime FactorsTreatment OutcomeDatabases, FactualRetrospective StudiesRisk AssessmentDisease-Free SurvivalKaplan-Meier EstimateProportional Hazards ModelsObesity Paradox