Diabetes worsens the surgical outcomes in cirrhotic patients with hepatocellular carcinoma.
Diabetes is a known risk factor for developing hepatocellular carcinoma (HCC).  Reported rates of diabetes are higher in chronic hepatitis, cirrhosis and HCC patients.  However, its effects on postoperative recurrence and survival with HCC are controversial.  This study offers a retrospective analysis of the impacts of diabetes on postoperative recurrence and survival in patients with cirrhosis and HCC.  A total of 389 cirrhotic patients who underwent curative resection for primary HCC at our institution between January 2000 and December 2008 were enrolled.  Of them, 272 (70%) patients were classified into a non-diabetes group and 117 (30%) patients into the diabetes group.  The diabetes group was divided into an oral hypoglycemic agent (OHA) control group (n = 100) and an insulin control group (n = 17).  The result indicates that the diabetes group had a higher postoperative recurrence rate and poorer long-term survival rate (p = 0.001 vs. 0.01).  There was no significant difference in recurrence-free survival rate between the OHA control group and the insulin control group (p = 0.17).  The insulin control group had a poorer long-term surgical outcome than the OHA control group (p = 0.035).  In conclusion, our results suggest that diabetes is an independent risk factor for postoperative recurrence and surgical survival of cirrhotic HCC patients.  Cirrhotic HCC patients with diabetes who received hepatic resection should be closely followed-up for postoperative recurrence and long-term outcome.  Moreover, an effective peri-operative sugar control planning in HCC patients with diabetes should be established.
Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan.
Chin-Tsung
CT
Ting
Ran-Chou
RC
Chen
Chien-Cheng
CC
Chen
Mao-Ho
MH
Liu
Dachen
D
Chu
Nai-Wen
NW
Kuo
D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D048909:Diabetes Complications / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D012709:Serum Albumin; D000410:Alanine Transaminase; D001663:Bilirubin