Abstract
Background
There are scarce data regarding the impact of diabetes mellitus on the prognosis of hepatocellular carcinoma managed conservatively. The objective of this study was to compare the overall survival among diabetic and non-diabetic patients suffering from hepatocellular carcinoma and treated mainly by non-surgical means.
Methods
We identified patients who underwent treatment for hepatocellular carcinoma over a period of 6.5 years at a single center in Lahore, Pakistan. Data regarding age, gender, morphology of tumor, size of tumor, Child-Pugh class, the Barcelona-Clínic Liver Cancer (BCLC) stage, treatment given, and outcome was retrieved from the medical records. Patients were classified as diabetic if there were at least two documented readings of fasting blood glucose level of more than 126 mg/dl or random blood glucose of more than 200 mg/dl or the patient was already diagnosed and on oral hypoglycemic agents or insulin. Statistical tests were applied to test for differences between diabetic and non-diabetic patients in terms of clinical features at presentation, treatments received, and disease outcomes.
Results
A total of 282 patients were diagnosed as having hepatocellular carcinoma during the study period. Diabetic and non-diabetic patients were comparable in terms of the mean age at diagnosis of hepatocellular carcinoma, sex, whether the tumor was unifocal or multifocal, Child-Pugh class, BCLC stage, and infection with hepatitis B and/or C virus. Diabetic patients were significantly more likely to have initial alpha-feto protein levels lower than 200 IU/ml compared to non-diabetic patients. There was no difference among diabetic and non-diabetic patients in terms of the treatments they received or the outcomes. Non-diabetic and diabetic patients had a mean disease-free survival of 8.29 and 6.95 months, respectively, and overall survival of 15.48 and 15.36 months, respectively. Multivariate linear regression analyses, after adjusting for age and gender of the patient and the BCLC stage of the tumor among the subset of patients documented to have died during the follow-up period, showed that there was no significant difference between diabetic and non-diabetic patients in terms of overall survival. BCLC stage, however, was significantly associated with overall survival.
Conclusion
Diabetes mellitus has no prognostic significance in patients with hepatocellular carcinoma.
Similar content being viewed by others
References
Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243(3):321–8.
Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24(14):2137–50.
El-serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004;126(2):460–8.
Hassan MM, Hwang LY, Hatten CJ, Swaim M, Li D, James L, et al. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology. 2002;36(5):1206–13.
Ikeda Y, Shimada M, Hasegawa H, Gion T, Kajiyama K, Shirabe K, et al. Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection. Hepatology. 1998;27(6):1567–71.
Huo TI, Lui YW, Huang YH, Chau GY, Wu JC, Lee PC, et al. Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: a longitudinal study. Am J Gastroenterol. 2003;98:2293–8.
Poon RTP, Fan ST, Wong J. Does diabetes mellitus influence the perioperative outcome or long term prognosis after resection of hepatocellular carcinoma? Am J Gastroenterol. 2002;97:1480–8.
Amarapurkar DN, Patel ND, Kamani PM. Impact of diabetes mellitus on outcome of HCC. Ann Hepatol. 2008;7(2):148–51.
Toyoda H, Kumada T, Nakano S, Takeda I, Sugiyama K, Kiriyama S, et al. Impact of diabetes mellitus on prognosis of patients with hepatocellular carcinoma. Cancer. 2001;91(5):957–63.
Conflict of Interest
Authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Masood, M.A., Zafar, W. & Yusuf, M.A. Is Diabetes Mellitus a Poor Prognostic Factor for Hepatocellular Carcinoma?. J Gastrointest Canc 45, 448–451 (2014). https://doi.org/10.1007/s12029-014-9631-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12029-014-9631-x