title: Diabetes, body mass index, and outcomes in hepatocellular carcinoma patients undergoing liver transplantation.
abstract: For many cancers, features of the metabolic syndrome, such as diabetes and obesity, have been associated with both increased risk of cancer development and poor outcomes.
  
  
  METHODS
  We examined a large retrospective cohort of 342 consecutive patients who underwent liver transplantation for hepatocellular carcinoma between January 1999 and July 2010 at our institution. We evaluated the relationship between diabetes, obesity, hepatocellular carcinoma (HCC) recurrence, and overall survival.
  
  
  RESULTS
  We found that a body mass index (BMI) higher than 30 was an independent predictor of poor overall survival in a multivariable Cox model, approximately doubling the risk of death after transplantation. A BMI higher than 30 was also a predictor of recurrent HCC, although this was of borderline statistical significance (hazard ratio for recurrence, 1.9; 95% confidence interval, 0.9-4.1). We also found increased BMI to be an independent predictor of microvascular invasion within HCC tumors, lending a possible explanation to these results. Those with diabetes showed worsened overall survival compared with those without diabetes in univariate but not multivariable analysis, possibly related to longer wait times.
  
  
  CONCLUSIONS
  Our findings suggest a relationship between higher BMI, tumor vascular invasion, increased recurrence, and worsened overall survival. These findings may help explain why those with high BMI have worse outcomes from their cancers. A better understanding of the role of obesity and diabetes in patients with cancer should help develop better predictors of outcome and improved treatment options for patients with HCC.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. aas54@columbia.edu
authors.forename: Abby B
authors.initials: AB
authors.lastname: Siegel
authors.forename: Emerson A
authors.initials: EA
authors.lastname: Lim
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.forename: William
authors.initials: W
authors.lastname: Brubaker
authors.forename: Rosa D
authors.initials: RD
authors.lastname: Rodriguez
authors.forename: Abhishek
authors.initials: A
authors.lastname: Goyal
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Verna
authors.forename: Jonah
authors.initials: J
authors.lastname: Zaretsky
authors.forename: Karim
authors.initials: K
authors.lastname: Halazun
authors.forename: Lorna
authors.initials: L
authors.lastname: Dove
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Helen
authors.initials: H
authors.lastname: Remotti
authors.forename: Yael J
authors.initials: YJ
authors.lastname: Coppleson
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009519:New York City; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome