The level of fasting serum insulin, but not adiponectin, is associated with the prognosis of early stage hepatocellular carcinoma

Abstract

Abstract. Impaired glucose tolerance influences the prognosis of hepatocellular carcinoma (HCC), but this mechanism is still not fully understood. We investigated the impact of the fasting serum levels of insulin and adiponectin on the prognosis of HCC and its recurrence. One hundred and forty patients with newly diagnosed HCC were enrolled in the prognosis study. Their fasting serum levels of insulin and adiponectin were determined. Of 140 patients, 59 patients who underwent curative treatment were subjected to analysis of the recurrence-free survival. The 140 patients were divided into two groups by the 50th percentile value of insulin (7.73 μIU/ ml) or total adiponectin (6.95 μg/ml). Kaplan-Meier analysis indicated that high insulin group (>7.73 μIU/ml) exhibited a significantly poorer prognosis than low insulin group (<7.73 μIU/ml) in early stage HCC (P=0.018). In contrast, the level of total adiponectin had no impact on the prognosis of HCC. Multivariate analysis indicated that fasting hyperinsulinemia was an independent risk factor for a poorer prognosis in early stage HCC (P=0.044). Likewise, KaplanMeier analysis indicated that the recurrence-free survival of high insulin group was significantly lower than that of low insulin group (P=0.017). The level of total adiponectin had no impact on the recurrence-free survival of HCC. Multivariate analysis indicated that fasting hyperinsulinemia was an independent risk factor for the lower recurrence-free survival of HCC (P=0.049). In conclusion, our study suggests that the fasting insulin level affects the clinical course of early stage HCC.

Preoperative serum retinol-binding protein 4 is associated with the prognosis of patients with hepatocellular carcinoma after curative resection

“…Moreover, serum RBP4, together with venous invasion and TNM stage, was identiWed as an independent risk factor of prognosis of patients with HCC. Opposite to our results, previous study suggested circulating insulin correlated with mortality in patients with colorectal cancer (Wolpin et al 2009) and HCC (Miuma et al 2009). The discrepancy may be attributed by the following reasons.…”

“…The eVects of insulin are rather distinct between diVerent tumor types. The study of Miuma et al (2009) performed in early stage HCC and the liver disease background of patients with HCC was also diVerent from the patients recruited in our study. In summary, we suggest that serum RBP4, independent of serum insulin and IR, was a prognostic factor of HCC.…”

“…This conclusion was then supported by another study showing that insulin use was associated with increased risk of pancreatic cancer in patients with diabetes (Li et al 2009). The impacts of IR on the prognosis of cancer were demonstrated by studies showing enhanced circulating insulin level was an independent factor for mortality after colorectal cancer resection (Wolpin et al 2009), and high fasting serum insulin was associated with signiWcantly poorer OS and disease-free survival (DFS) in patients with early stage HCC (Miuma et al 2009). …”

Insulin resistance and chronic liver disease

“…In patients with HCV infection, HCC development is associated with increased fasting serum insulin level and by HOMA-IR [87] . Moreover, HCC recurrence has also been demonstrated to be related to HOMA-IR [88,89] . In addition, prognosis is worse in HCC patients with increased fasting serum insulin level or HOMA-IR [90] .…”

Significance of Hepatic Insulin Clearance in Patients with Chronic Hepatitis C and Non-alcoholic Fatty Liver Disease

“…Hyperinsulinemia is an important pathophysiological factor and previous studies have reported that it was associated with cardiovascular disease (17) and hepatocellular carcinoma (HCC) (18). Moreover, our previous study showed that hyperinsulinemia affected the clinical course of early stage HCC (19).…”