Abstract
It remains limited whether diabetes mellitus (DM) and hypertension (HTN) affect the prognosis of advanced hepatocellular carcinoma (HCC) treated with sorafenib. Our study attempted to elucidate the roles of DM/HTN and the effects of diabetes medications among advanced HCC patients receiving sorafenib. From August 2012 to February 2018, 733 advanced HCC patients receiving sorafenib were enrolled at China Medical University, Taichung, Taiwan. According to the presence/absence of DM or HTN, they were divided into four groups: control [DM(-)/HTN(-), n = 353], DM-only [DM(+)/HTN(-), n = 91], HTN-only [DM(-)/HTN(+), n = 184] and DM+HTN groups [DM(+)/HTN(+), n = 105]. Based on the types of diabetes medications, there were three groups among DM patients (the combined cohort of DM-only and DM+HTN groups), including metformin (n = 63), non-metformin oral hypoglycemic agent (OHA) (n = 104) and regular insulin (RI)/neutral protamine hagedorn (NPH) groups (n = 29). We then assessed the survival differences between these groups. DM-only and DM+HTN groups significantly presented longer overall survival (OS) than control group (control vs. DM-only, 7.70 vs. 11.83 months, p = 0.003; control vs. DM+HTN, 7.70 vs. 11.43 months, p = 0.008). However, there was no significant OS difference between control and HTN-only group (7.70 vs. 8.80 months, p = 0.111). Besides, all groups of DM patients showed significantly longer OS than control group (control vs. metformin, 7.70 vs. 12.60 months, p = 0.011; control vs. non-metformin OHA, 7.70 vs. 10.80 months, p = 0.016; control vs. RI/NPH, 7.70 vs. 15.20 months, p = 0.026). Rather than HTN, DM predicts better prognosis in advanced HCC treated with sorafenib. Besides, metformin, non-metformin OHA and RI/NPH are associated with longer survival among DM-related advanced HCC patients receiving sorafenib.
Highlights
In 2018, liver cancer is estimated to be the sixth most frequently diagnosed cancer and the fourth prevailing cause of cancer-related deaths globally with approximately 841,000 new cases and 782,000 deaths [1]
All groups of diabetes mellitus (DM) patients showed significantly longer overall survival (OS) than control group
Rather than HTN, DM predicts better prognosis in advanced hepatocellular carcinoma (HCC) treated with sorafenib
Summary
In 2018, liver cancer is estimated to be the sixth most frequently diagnosed cancer and the fourth prevailing cause of cancer-related deaths globally with approximately 841,000 new cases and 782,000 deaths [1]. Various therapeutic modalities have been applied in HCC management, the mortality of HCC patients is still high due to a large proportion of cases diagnosed with advanced tumors [3]. Patients with advanced stage HCC are defined as those with intra-hepatic venous invasion and/or extra-hepatic metastases but preserved liver function (Child-Pugh class A) [4]. Systemic therapy is recommended for patients with advanced HCC or well-selected HCC patients with ChildPugh class B cirrhosis plus intra-hepatic venous invasion and/or metastatic disease [6]. Sorafenib has been validated to improve the prognosis of advanced HCC [8] It remains limited whether diabetes mellitus (DM) and hypertension (HTN) affect the prognosis of advanced hepatocellular carcinoma (HCC) treated with sorafenib. Our study attempted to elucidate the roles of DM/HTN and the effects of diabetes medications among advanced HCC patients receiving sorafenib
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