Abstract
BackgroundPrevious studies suggested that diabetes mellitus was associated with cancer risk and prognosis, but studies investigating the relationship between diabetes mellitus and survival in patients with hepatocellular carcinoma (HCC) reported inconsistent findings. To derive a more precise estimate of the prognostic role of diabetes mellitus in HCC, we systematically reviewed published studies and carried out a meta-analysis.MethodsEligible articles were identified in electronic databases from their inception through September 16, 2013. To evaluate the correlation between diabetes mellitus and prognosis in HCC, the pooled hazard ratios (HR) and their 95% confidence intervals (95% CI) for poorer overall and disease-free survivals were calculated by standard meta-analysis techniques with fixed-effects or random-effects models.Results21 studies with a total of 9,767 HCC patients stratifying overall survival and/or disease-free survival in HCC patients by diabetes mellitus status were eligible for meta-analysis. 20 studies with a total of 9,727 HCC cases investigated the overall survival, and 10 studies with a total of 2,412 HCC patients investigated the disease-free survival. The pooled HRs for overall survival and disease-free survival were 1.46 (95% CI, 1.29 to 1.66; P<0.001) and 1.57 (95% CI, 1.21 to 2.05; P = 0.001), respectively. The adjusted HRs for overall survival and disease-free survival were 1.55 (95% CI, 1.27 to 1.91; P<0.001) and 2.15 (95% CI, 1.75 to 2.63; P<0.001), respectively. In addition, for patients receiving hepatic resection, diabetes mellitus was associated with both poorer overall survival and poorer disease-free survival, and for patients receiving non-surgical treatment or patients receiving radiofrequency ablation, diabetes mellitus was associated with poorer overall survival. There was no evidence for publication bias.ConclusionDiabetes mellitus is independently associated with both poorer overall survival and poorer disease-free survival in HCC patients.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies and a major cause of death among both sexes, and despite diagnostic and therapeutic improvements, its incidence and mortality rates have obviously increased in recent years, especially in Asian countries [1,2]
The survival of hepatocellular carcinoma (HCC) patients has been improved by advances in surgical techniques and perioperative management, such as radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE), long-term survival remains unsatisfactory owing to the high rate of recurrence and metastasis [3,4]
There is some epidemiologic evidence suggesting that diabetes mellitus is associated with poorer prognosis in cancer patients, but previous studies investigating the relationship between diabetes mellitus and survival in HCC patients have reported inconsistent findings [11,12,13,14]
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancies and a major cause of death among both sexes, and despite diagnostic and therapeutic improvements, its incidence and mortality rates have obviously increased in recent years, especially in Asian countries [1,2]. There is some epidemiologic evidence suggesting that diabetes mellitus is associated with poorer prognosis in cancer patients, but previous studies investigating the relationship between diabetes mellitus and survival in HCC patients have reported inconsistent findings [11,12,13,14]. To derive a more precise estimate of the prognostic significance of diabetes mellitus in HCC patients, we systematically review published studies and carried out a meta-analysis by using standard meta-analysis techniques (Checklist S1). Previous studies suggested that diabetes mellitus was associated with cancer risk and prognosis, but studies investigating the relationship between diabetes mellitus and survival in patients with hepatocellular carcinoma (HCC) reported inconsistent findings. To derive a more precise estimate of the prognostic role of diabetes mellitus in HCC, we systematically reviewed published studies and carried out a meta-analysis
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