Abstract
BackgroundDiabetes mellitus (DM) is associated with higher incidence and poorer prognosis of hepatocellular carcinoma (HCC). The influence of DM on patient survival in different HCC stages is not known.MethodsA prospective dataset of 3,182 HCC patients was collected between 2002 and 2014. Patients were divided into three groups according to BCLC stages (BCLC stage 0 and stage A, BCLC stage B, BCLC stage C and stage D). We compared the cumulative survival rate of diabetic and non-diabetic patients in different BCLC groups. The correlation between DM and overall survival was also analyzed by multivariate Cox regression model within each group.ResultsDM is present in 25.2% of all patients. Diabetic patients had lower cumulative survival in BCLC stage 0 plus BCLC stage A group (log rank p<0.001), and BCLC stage B group (log rank p = 0.012), but not in BCLC stage C plus BCLC stage D group (log rank p = 0.132). Statistically significant differences in overall survival are found between diabetic and non-diabetic patients in BCLC stage 0 plus stage A group (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI] 1.08–1.93, p = 0.013), and BCLC stage B (adjusted HR = 1.77, 95% CI 1.24–2.51, p = 0.002). In contrast, the survival difference is not seen in BCLC stage C plus stage D group (adjusted HR = 1.09, 95% CI 0.90–1.30, p = 0.387).ConclusionsDM is prevalent in HCC, and is associated with lower survival rate in HCC patients with BCLC stage 0 plus stage A and B, but not in those with BCLC stage C plus stage D.
Highlights
Hepatocellular carcinoma (HCC) is the fifth common neoplasm in men and the seventh in women
The survival difference is not seen in Barcelona Clınic Liver Cancer (BCLC) stage C plus stage D group
We aim to explore the prognostic role of diabetes mellitus (DM) in different BCLC stages
Summary
Hepatocellular carcinoma (HCC) is the fifth common neoplasm in men and the seventh in women. It contributed to 745,000 deaths in year 2012 and was the second leading cause of cancer-related mortality worldwide.[1] Well-established risk factors for HCC include chronic hepatitis B virus (HBV) infection, chronic hepatitis C virus (HCV) infection, aflatoxin B1, and alcohol consumption.[2, 3] The pathogenic and prognostic roles of metabolic factors, such as diabetes mellitus (DM), metabolic syndrome, or obesity, had been studied.[4,5,6] Epidemiologic studies have disclosed association between presence of DM and higher HCC incidence, suggesting that DM is an independent risk factor for development of HCC.[7,8,9,10]. Wang et al reported lower overall and disease-free survival in DM patients with cirrhosis and HCC, but not in their noncirrhotic counterparts.[20]
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