Association Between Metabolic Syndrome and Long-Term Prognosis in Patients with Perihilar Cholangiocarcinoma Treated...

Metabolic syndrome (MetS) was linked to poor cancer outcomes, but its impact on perihilar cholangiocarcinoma (pCCA) survival postresection was unclear. In this study, we investigated the association between MetS and long-term prognosis in patients with pCCA after curative-intent resection.

Consecutive patients with pCCA who underwent curative-intent resection at four hospitals (2018-2023) were enrolled and stratified into the MetS and non-MetS groups. Mets was diagnosed when patients met three or more of the following five criteria: (1) body mass index ≥ 25 kg/m²; (2) systolic blood pressure ≥ 130 mmHg or diastolic ≥ 85 mmHg, or prior hypertension treatment; (3) fasting plasma glucose ≥ 6.1 mmol/L or prior diabetes diagnosis; (4) fasting triglycerides ≥ 1.7 mmol/L; and (5) high-density lipoprotein cholesterol < 1.04 mmol/L. non-Mets was defined as meeting fewer than three criteria. Inverse probability of treatment weighting was applied to balance tumor-related confounders. The log-rank test was used to compare overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Cox regression was performed to identify independent prognostic factors.

Of the 321 included patients, 78 (24.3%) had MetS. After inverse probability of treatment weighting, the MetS and non-MetS groups comprised 77.30 and 242.21 cases, respectively, with no significant differences in tumor factors (P > 0.05). The MetS group had significantly lower 5-year OS (29.5% vs. 32.9%, P = 0.039), 5-year RFS (18.1% vs. 26.1%, P = 0.025), and 5-year CSS (30.8% vs. 34.8%, P = 0.048). MetS was an independent predictor of worse OS, RFS, and CSS.

Approximately 25% of patients with pCCA who underwent curative-intent resection had MetS, which significantly increased early recurrence risk and worsened long-term survival.