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Master Thesis

Impact du syndrome métabolique et de la MAFLD dans le traitement par radiofréquence percutanée du carcinome hépatocellulaire

Abstract : Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is one of the leading causes of hepatocellular carcinoma (HCC) worldwide. Long-term outcomes after percutaneous radiofrequency ablation (RFA) in these patients have been poorly studied. We aim to determine tolerance profile and long-term survival after multibipolar RFA in patients with MAFLD-HCC compared to other etiologies as well as the prognostic impact of metabolic syndrome. Patients and methods: Patients who underwent multibipolar RFA as first curative treatment for HCC within Milan criteria between 2008 and 2018 were enrolled in this multicenter retrospective cohort study. Patients with MAFLD-HCC were compared to those with alcoholic liver disease (ALD), hepatitis B virus (HBV) and hepatitis C virus (HCV). Results: Among 520 patients enrolled, 390 patients had at least one component of metabolic syndrome including obesity in 155 patients. 62 patients (12,6%) had MAFLDHCC, 225 (45,5%) had ALD-HCC, 36 (7,3%) had HBV-HCC and 171 (34,6%) had HCV-HCC. Patients with MAFLD-HCC were significantly older (median age 72,6 years, p < 0,0001), more often obese (median BMI 30,3 kg/m2, p < 0,0001), more often to have components of metabolic syndrome, had more ischemic heart disease (17,7%, p = 0,017) and more grade II-III esophageal varices (39,3%, p = 0,004). There were no differences in morbidity, tumor recurrence and overall survival among patients with MAFLD-HCC versus other etiologies (median overall survival of 79 months and 1-year, 3-year and 5-year overall survival of 90%, 71% and 59% in patients with MAFLD-HCC, respectively). There was no prognostic impact of metabolic syndrome components on adverse events and oncologic outcomes of RFA for HCC. Conclusion: Patients with MAFLD-HCC or metabolic syndrome have a prolonged overall survival after multibipolar RFA without increased risks of morbidity or tumor recurrence.
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Thi Thu Nga Nguyen. Impact du syndrome métabolique et de la MAFLD dans le traitement par radiofréquence percutanée du carcinome hépatocellulaire. Médecine humaine et pathologie. 2020. ⟨dumas-03197685⟩