Abstract
BackgroundThe impact of pre-existing diabetes mellitus (DM) on hepatocellular carcinoma (HCC) occurrence and prognosis is complex and unclear. The aim of this meta-analysis is to evaluate the association between pre-existing diabetes mellitus and hepatocellular carcinoma occurrence and prognosis.MethodsWe searched PubMed, Embase and the Cochrane Library from their inception to January, 2011 for prospective epidemiological studies assessing the effect of pre-existing diabetes mellitus on hepatocellular carcinoma occurrence, mortality outcomes, cancer recurrence, and treatment-related complications. Study-specific risk estimates were combined by using fixed effect or random effect models.ResultsThe database search generated a total of 28 prospective studies that met the inclusion criteria. Among these studies, 14 reported the risk of HCC incidence and 6 studies reported risk of HCC specific mortality. Six studies provided a total of 8 results for all-cause mortality in HCC patients. Four studies documented HCC recurrence risks and 2 studies reported risks for hepatic decomposition occurrence in HCC patients. Meta-analysis indicated that pre-existing diabetes mellitus (DM) was significantly associated with increased risk of HCC incidence [meta-relative risk (RR) = 1.87, 95% confidence interval (CI): 1.15–2.27] and HCC-specific mortality (meta-RR = 1.88, 95%CI: 1.39–2.55) compared with their non-DM counterparts. HCC patients with pre-existing DM had a 38% increased (95% CI: 1.13–1.48) risk of death from all-causes and 91% increased (95%CI: 1.41–2.57) risk of hepatic decomposition occurrence compared to those without DM. In DM patients, the meta-RR for HCC recurrence-free survival was 1.93(95%CI: 1.12–3.33) compared with non-diabetic patients.ConclusionThe findings from the current meta-analysis suggest that DM may be both associated with elevated risks of both HCC incidence and mortality. Furthermore, HCC patients with pre-existing diabetes have a poorer prognosis relative to their non-diabetic counterparts.
Highlights
Hepatocellular carcinoma (HCC) is the seventh most common cancer and the fourth leading cause of cancer related death in the world [1]
Outcomes reported in each article included hepatocellular carcinoma (HCC) occurrence (n = 14) [17,18,19,20,21,22,23,24,25,26,27,28,29,61], HCC-specific mortality (n = 6) [56,58,61,63,64,68], allcause mortality (n = 6) [55,60,62,66,67,69], recurrence-free survival (n = 4) [57,59,67,69], and hepatic decomposition as a complication (n = 2) [62,65]
When analysis was restricted to HCC patients receiving curative surgery only, we found that the recurrence risk in diabetic patients was 1.66(95%confidence interval (CI): 0.96–2.87) compared to non-diabetic patients
Summary
Hepatocellular carcinoma (HCC) is the seventh most common cancer and the fourth leading cause of cancer related death in the world [1]. More than 80% of HCC cases develop in Asian and African countries with 55% of the cases reported in China alone [2], In contrast, the incidence of HCC in the United States and Western Europe is relatively low These geographical variations are in part explained by variations in the prevalence of chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV). In the United States, for instance, the age-adjusted incidence of HCC has recently more than tripled, from 1.6/100,000 in 1975 to 4.9/100,000 in 2005 [6] The cause of this increase in low-rate areas is not well understood but may reflect the changing patterns of HCC etiology. The aim of this meta-analysis is to evaluate the association between pre-existing diabetes mellitus and hepatocellular carcinoma occurrence and prognosis
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