The impact of diabetes on the prognosis of patients with different stages of hepatocellular carcinoma

• Main Authors: Yuan,MEI-HSIA, 袁美霞
• Other Authors: CHEN, CHU-CHIEH
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/2n9bm5

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 107 === Background: Hepatocellular carcinoma (HCC) is a common cancer globally. Published studies showed that diabetes mellitus (DM) may affect the incidence, risk of tumor recurrence, and overall survival in HCC patients through specific mechanisms. However, very few studies focused on the impact of DM on different cancer stages in different patient groups. Objectives: To evaluate the prognostic impact of DM on HCC patients stratified by liver dysfunction, Milan criteria and performance status defined in the Barcelona Clínic Liver Cancer (BCLC) scheme. Methods: By using the database in a medical center in Taiwan, we retrospectively investigated the newly diagnosed HCC patients between Jan 1, 2002 and Dec 12, 2016; a total of 3,573 patients were identified. The survival differences between diabetic and non-diabetic patients in different patient subgroups were compared by the Kaplan-Meier method with a log-rank test. The multivariate Cox proportional hazards model was used to determine the independent prognostic predictors stratified by liver reserve, Milan criteria and performance status to clarify the association between DM and long-term survival. Results: The mean age was 65 years, with males in 2,733(77%)and females in 840(%). Among 3,573 HCC patients, 910(26%) were diabetic. Of all patients, DM was not an independent survival predictor in the Cox model (hazard ratio [HR]: 1.084, 95% confidence interval [CI]: 0.984-1.194，p=0.1044). In subgroup analysis, DM did not significantly influence the survival either in Child-Turcotte-Pugh (CTP)class A or class B or C patient subgroups. For patients within the Milan criteria, DM patients were associated with a decreased survival compared with those without DM (HR: 1.360, 95% CI:1.155-1.601, p=0.0002), but no significant survival difference was found between diabetic and non-diabetic patients beyond the Milan criteria (HR:1.012, 95% CI:0.897-1.142, p=0.8464). For patients with performance status 0, diabetic patients had a decreased survival compared to non-diabetic patients (HR: 1.213, 95% CI: 1.055-1.394, p=0.0067). However, for patients with performance status 1-4, no significant survival difference was found (HR: 0.968, 95% CI: 0.845-1.108, p=0.6341). Conclusions: DM is highly prevalent in HCC patients, and has a differential and distinct survival impact for different patient subgroups.DM is an independent survival predictor among patients within the Milan criteria and good performance status.These patients should be closely monitored, and aggressive treatment including tight blood glucose control should be considered.