Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation

Abstract

AIMTo determine whether diabetes mellitus (DM) affects prognosis/recurrence after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).METHODSA retrospective study was conducted between January 2000 and August 2013 on 1631 patients with HBV-related HCC who underwent LT with antiviral prophylaxis. Patient data were obtained from the China Liver Transplant Registry (https://www.cltr.org/). To compare the outcomes and tumor recurrence in the HBV-related HCC patients with or without DM, statistical analyses were conducted using χ2 tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis.RESULTSUnivariate analysis of 1631 patients who underwent LT found overall 1-, 3- and 5-year survival rates of 79%, 73% and 71% respectively in the DM patients, and 84%, 78% and 76% in the non-DM patients respectively. Overall survival rate differences after LT between the two groups were significant (P = 0.041), but recurrence-free survival rates were not (P = 0.096). By stratified analysis, the overall survival rates in DM patients for age > 50 years (P = 0.002), the presence of vascular invasion (P = 0.096), tumors ≤ 3 cm (P = 0.047), two to three tumor nodules (P = 0.007), Child-Pugh grade B (P = 0.018), and pre-LT alanine aminotransferase levels between 40 and 80 IU/L (P = 0.017) were significantly lower than in non-DM patients. Additionally, serum α-fetoprotein level > 2000 ng/mL (P = 0.052) was associated with a significant survival difference trend between DM and non-DM patients. Multivariate analysis showed that the presence of DM (P < 0.001, HR = 1.591; 95%CI: 1.239-2.041) was an independent predictor associated with poor survival after LT.CONCLUSIONHBV-related HCC patients with DM have decreased long-term overall survival and poor LT outcomes. Prevention strategies for HCC patients with DM are recommended.

Metabolic Disorders across Hepatocellular Carcinoma in Italy

“…This analysis showed that only diabetes marginally reduces the overall survival of HCC patients. Our result supports and extends to Western HCC patients -managed in an updated way -the findings of quite old studies usually based on small surgical cohorts of Asiatic patients, reporting an adverse impact of diabetes on the outcome of patients with cirrhosis and HCC [36][37][38][39][40]. Nevertheless, despite these evidences and the well know pathogenic role of diabetes on cardiac, renal, and neurologic diseases, other studies report a better prognosis of patients with HCC and diabetes as compared to non-diabetic patients [8,41].…”

Intention‐to‐treat analysis of liver transplantation for hepatocellular carcinoma: The impact of pre‐existing diabetes mellitus

“…To our knowledge, there are several studies that have compared the impact of DM on survival and tumour recurrence in HCC patients. Zhang et al reported that DM patients had significantly worse overall survival than those without DM, but there was no significant difference in recurrence‐free survival rates between these two groups. However, Connolly et al indicated that though the median survival time for the non‐DM patients was longer than that for the DM patients, no significant differences were observed.…”

“…Clinical studies regarding the impact of patient pre‐existing DM on post‐transplant HCC recurrence are still limited, and whether DM adversely affects the prognosis of HCC patients remains controversial in transplant cohort. Some studies have shown that prior DM does not impact recurrence and patient survival; others found worsened overall survival but no increased risk of recurrence . Moreover, all of these studies included limited numbers of patients owing to cases from single centre or with homologous disease background; possible confounding variables could not be taken into account, and none of these studies was performed on an intention‐to‐treat strategy.…”

“…Some studies have shown that prior DM does not impact recurrence and patient survival 18,19 ; others found worsened overall survival but no increased risk of recurrence. 20,21 Moreover, all of these studies included limited numbers of patients owing to cases from single centre or with homologous disease background; possible confounding variables could not be taken into account, and none of these studies was performed on an intentionto-treat strategy. Recently, Samoylova et al 22 have shown that identification of HCC recurrence data in the United Network for Organ Sharing database was feasible and valid.…”

Metabolic disorders across hepatocellular carcinoma in Italy

“…Our result supports and extends to Western HCC patients-managed in an updated way-the findings of quite old studies usually based on small surgical cohorts of Asiatic patients, reporting an adverse impact of diabetes on the outcome of patients with cirrhosis and HCC. [36][37][38][39][40] Nevertheless, despite these evidences and the well-known pathogenic role of diabetes on cardiac, renal and neurological diseases, other studies report a better prognosis of patients with HCC and diabetes as compared to non-diabetic patients. 8,41 This surprising and difficult to understand discrepancy probably relies on the effect of selection biases and confounding factors on results.…”