Is Higher BMI Associated with Worse Overall Mortality in Hepatocellular Carcinoma Patients? An Evidence Based Case Report

Alessa Fahira, Ratu Shafira Hanifah, Mohamad Prasetio Wardoyo, Amirah Deandra Diba, Rahadian Ramadhan, Julie Dewi Barliana, Chyntia Olivia Jasirwan

Abstract


Background: liver cancer is currently the second deadliest cancer in the world with hepatocelullar carcinoma (HCC) being the commonest form—accounting 90% of all its cases. With the current global alarming increase of obesity, there is hence an increase of fatty liver disease cases, which is one of the major non-viral etiology of cirrhosis in the world. The objective of this study is to evaluate whether obese HCC patients have worse survival outcome. Methods: PubMed, Cochrane, Scopus, ProQuest, and EBSCOhost were comprehensively searched for systematic review and cohort prognostic researches studying overall survival of HCC patients who are underweight and obesity according to their BMI. Three studies were selected and critically appraised. Data were then summarized descriptively. Results: the three studies included consist of one meta-analysis and two cohort studies. Meta-analysis study stated no association between overweight and obesity status with higher mortality rate in Asian race HCC patients (aHR, 1.10; 95% CI, 0.63-1.92). A cohort study from Japan reported while there was a significant difference of mortality rate in obese HCC patients in bivariate analysis, adjustment with other important prognostic factors with multivariate analysis found no significant correlation between obesity and HCC-related mortality rate (aHR, 1.00; 95% CI, 0.83-1.22). Another cohort study from China reported that HCC-related mortality rate in patients with higher BMI was lower than in patients with lower BMI (aHR, 0.347; 95% CI, 0.239-0.302). Conclusion: there is no association between higher BMI with HCC-related mortality in Asian race patients.

Keywords


Hepatocelullar carcinoma; liver cancer; mortality; body mass index (BMI); overweight; obesity; prognosis; hepatolgy

References


Llovet J, Zucman-Rossi J, Pikarsky E, et al. Hepatocellular carcinoma. Nature Rev Dis Primers. 2016;2:16018.

Park JW, Chen M, Colombo M, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int. 2015;35(9):2155-66.

Lesmana LA, Waspodo AS, Gani RA, Hasan I, Siregar L, Sulaiman AS. Konsensus Nasional Penatalaksanaan Karsinoma Sel Hati. Jakarta: Perhimpunan Peneliti Hati Indonesia; 2017.

Arrieta O, Cacho B, Morales-Espinosa D, Ruelas-Villavicencio A, Flores-Estrada D, Hernández-Pedro N. The progressive elevation of alpha fetoprotein for the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis. BMC cancer. 2007;7(1):28.

Balogh J, David Victor III EH, Burroughs SG, Boktour M, Saharia A, Li X, Ghobrial RM, Monsour Jr HP. Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:41.

Hsiang JC, Bai WW, Raos Z, Stableforth W, Upton A, Selvaratnam S, Gane EJ, Gerred SJ. Epidemiology, disease burden and outcomes of cirrhosis in a large secondary care hospital in South Auckland, New Zealand. Intern Med J. 2015;45(2):160-9.

Schiavo L, Busetto L, Cesaretti M, Zelber-Sagi S, Deutsch L, Iannelli A. Nutritional issues in patients with obesity and cirrhosis. World J Gastroenterol. 2018;24(30):3330.

Kumar N, Choudhary NS. Treating morbid obesity in cirrhosis: A quest of holy grail. World J Hepatol. 2015;7(28):2819.

Diehl AM. Hepatic complications of obesity. Gastroenterol Clinics. 2010;39(1):57-68.

Hartz AJ, Rimm AA. Natural history of obesity in 6,946 women between 50 and 59 years of age. Am J Public Health. 1980;70(4):385-8.

Li Q, Xing H, Liu D, Li H. Negative impact of low body mass index on liver cirrhosis patients with hepatocellular carcinoma. World J Surgical Oncol. 2015;13(1):294.

Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131-40.

Gupta A, Das A, Majumder K, Arora N, Mayo HG, Singh PP, Beg MS, Singh S. Obesity is independently associated with increased risk of hepatocellular cancer-related mortality: A systematic review and meta-analysis. Am J Clinical Oncol. 2017 May.

Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012: Globocan 2012. Int J Cancer. 2015;136(5):E359–86.

Reeves HL, Zaki MYW, Day CP. Hepatocellular carcinoma in obesity, type 2 diabetes, and NAFLD. Dig Dis Sci. 2016;61(5):1234–45.

Møller H, Mellemgaard A, Lindvig K, Olsen JH. Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer. 1994;30A(3):344–50.

Wolk A, Gridley G, Svensson M, et al. A prospective study of obesity and cancer risk (Sweden). Cancer Causes Control. 2001;12(1):13–21.

Sanyal A, Poklepovic A, Moyneur E, Barghout V. Population-based risk factors and resource utilization for HCC: US perspective. Curr Med Res Opin. 2010;26(9):2183–91.

Ascha MS, Hanouneh IA, Lopez R, Tamimi TA-R, Feldstein AF, Zein NN. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51(6):1972–8.

Younossi ZM, Otgonsuren M, Henry L, et al. Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatol. 2015;62(6):1723–30.

Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. Adults. New Engl J Med. 2003;348(17):1625–38.


Full Text: PDF

Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 Acta Medica Indonesiana