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Liver Tumours Associated With Metabolic Syndrome Differ From Other Tumours HOBOKEN, NJ -- February 25, 2009 -- Hepatocellular carcinoma (HCC) in patients whose only risk factor is metabolic syndrome has distinct forms and structures compared with other liver tumours, according to a study published in the March issue of the journal Hepatology. Valerie Paradis, Beaujon Hospital, Paris, France, and colleagues analysed a series of liver cancers that arose in patients whose only risk factor for chronic liver disease was metabolic syndrome. They compared their findings with the characteristics of hepatocellular carcinomas that developed in the setting of other chronic liver diseases. Their retrospective analysis included 128 patients in their hospital who had undergone surgery to remove a liver tumour between 1995 and 2007. Of these, 81 patients had an overt cause of chronic liver disease such as hepatitis B or hepatitis C and 31 had features of the metabolic syndrome as their only risk factor. Sixteen patients had no identifiable risk factors. "Most hepatocellular carcinoma associated with features of metabolic syndrome as the only risk factor for chronic liver disease develop in nonfibrotic liver," the authors wrote. They found that just over 35% of liver tumours in these patients occurred in bridging fibrosis or cirrhosis, compared with 75% in the patients with chronic liver disease. "Our results suggest that well-recognised multistep progression, eg, fibrosis-cirrhosis-HCC, may not be the main carcinogenic pathway in the context of metabolic syndrome," they explained. The authors suggested that the metabolic syndrome itself could have a direct cancer-causing effect, perhaps through the effects of insulin, lipid peroxidation, or free radical oxidative stress. They noted that most tumours arising in the context of the metabolic syndrome were well differentiated -- nearly 65% compared with 28% in the patients with chronic liver disease. These tumours were more similar to those in patients with tumours from unknown causes, which also had better differentiation and a low prevalence of significant fibrosis. Interestingly, the researchers found that among the patients with metabolic syndrome, 5 cases of liver cancer were associated with liver cell adenoma. "Our results suggest that a significant percentage of hepatocellular carcinoma that developed in the context of metabolic syndrome without significant fibrosis arose from malignant transformation of liver cell adenoma," the authors wrote. SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version