Body Mass Index and Surgical Outcomes in Hepatocellular Carcinoma

Body mass index (BMI) has emerged as a key factor influencing both the development of hepatocellular carcinoma (HCC) and the results of its surgical management. While obesity is recognised as an independent risk factor for HCC through mechanisms such as insulin resistance, chronic inflammation and adipokine imbalance, its impact on perioperative safety and long-term outcomes remains complex. Studies have reported an ‘obesity paradox,’ whereby higher BMI may confer comparable or even improved survival following tumour ablation or hepatic resection, despite technical challenges in overweight patients. Conversely, malnutrition and low BMI often correlate with impaired liver function, greater postoperative morbidity and reduced overall survival. The interplay between body composition, nutritional reserves and tumour biology underpins risk stratification, surgical planning and postoperative support in diverse patient populations worldwide.

Research from Nature Portfolio

Recent genetic epidemiology work using Mendelian randomisation has provided robust evidence for a causal relationship between obesity-related traits, including BMI and body fat percentage, and HCC risk. By leveraging genome-wide data, investigators demonstrated that higher genetically predicted BMI significantly increases HCC susceptibility, likely via pathways involving insulin resistance, elevated inflammatory markers such as C-reactive protein, and dysregulated adipokine signalling. Bioinformatic analyses identified shared differentially expressed genes in obesity and HCC, implicating processes such as IL-17 signalling, viral transcription and cell-cycle regulation. These genes also showed negative associations with immune cell infiltration and markers of immunotherapy response in HCC, suggesting that obesity may promote tumour immune evasion. This work highlights obesity not only as a modifiable risk factor but also as a determinant of tumour microenvironment and potential perioperative immunological status.

Body Mass Index and Surgical Outcomes in Hepatocellular Carcinoma publication trend

The graph below shows the total number of articles in body mass index and surgical outcomes in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Body Mass Index (BMI): A measure of body fat based on weight relative to height, used to classify underweight, normal weight, overweight and obesity.

Hepatocellular Carcinoma (HCC): The most common primary liver cancer arising from hepatocytes, often associated with chronic liver disease.

Geriatric Nutritional Risk Index (GNRI): A score combining serum albumin and weight relative to ideal weight to assess nutritional risk and predict postoperative outcomes.

Prognostic Nutritional Index (PNI): A composite metric of serum albumin concentration and lymphocyte count used to evaluate preoperative nutritional and immunological status.

Mendelian Randomisation: A genetic epidemiology technique using inherited genetic variants as proxies for modifiable exposures (such as obesity) to infer causal relationships with disease risk.

References

1. Lower Geriatric Nutritional Risk Index and Prognostic Nutritional Index Predict Postoperative Prognosis in Patients with Hepatocellular Carcinoma. Nutrients (2024).
2. Relationship between Being Overweight and Clinical Outcomes of Ablation Therapy for Hepatocellular Carcinoma under Ultrasound Guidance: A Retrospective Analysis. Cancers (2023).
3. Investigating the causal association between obesity and risk of hepatocellular carcinoma and underlying mechanisms. Scientific Reports (2024).
4. Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy. PLOS ONE (2015).