Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: a longitudinal study.
OBJECTIVE
Patients with hepatocellular carcinoma (HCC) frequently have diabetes mellitus (DM) due to coexisting liver cirrhosis. The aim of this study was to assess the long-term impact of DM on the hepatic regenerative ability of HCC patients undergoing surgical resection.


METHODS
We retrospectively studied 245 HCC patients (210 male; age, 61 +/- 13 yr) with well-preserved liver functions undergoing resection. Forty (16%) of them were diabetic and were controlled with hypoglycemic agents. The Child-Pugh scoring system was used to evaluate the postoperative liver regeneration ability. The endpoint was the occurrence of hepatic decompensation, defined as a sustained increase in the Child-Pugh score of 2 or more points or the development of tumor recurrence.


RESULTS
Seventy-five patients (31%) developed hepatic decompensation during a follow-up period of 27 +/- 18 months (range, 3-75). DM (p = 0.001), large (>3 cm) tumor size (p = 0.044), and age > 65 yr (p = 0.058) were the factors associated with hepatic decompensation in univariate analysis. Multivariate Cox regression model analysis confirmed that DM (relative risk [RR] = 2.3, 95% CI = 1.4-3.7, p = 0.001) and tumor size > 3 cm (RR = 1.7, 95% CI = 1.1-2.7, p = 0.046) were independent prognostic predictors associated with the occurrence of hepatic decompensation; the respective 3- and 5-yr cumulative rates were 53% and 64% versus 27% and 50% for diabetic and nondiabetic patients, and 24% and 41% versus 38% and 60% for patients with small (< or =3 cm) versus large (>3 cm) tumors.


CONCLUSIONS
HCC patients with DM or large tumor size are at a cumulative increased risk for postoperative hepatic decompensation.
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Teh-Ia
TI
Huo
Wing-Yu
WY
Lui
Yi-Hsiang
YH
Huang
Gar-Yang
GY
Chau
Jaw-Ching
JC
Wu
Pui-Ching
PC
Lee
Full-Young
FY
Chang
Shou-Dong
SD
Lee
D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000453:epidemiology* / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome