Diabetes mellitus and poorer prognosis in hepatocellular carcinoma: a systematic review and meta-analysis.
BACKGROUND
Previous studies suggested that diabetes mellitus was associated with cancer risk and prognosis, but studies investigating the relationship between diabetes mellitus and survival in patients with hepatocellular carcinoma (HCC) reported inconsistent findings. To derive a more precise estimate of the prognostic role of diabetes mellitus in HCC, we systematically reviewed published studies and carried out a meta-analysis.


METHODS
Eligible articles were identified in electronic databases from their inception through September 16, 2013. To evaluate the correlation between diabetes mellitus and prognosis in HCC, the pooled hazard ratios (HR) and their 95% confidence intervals (95% CI) for poorer overall and disease-free survivals were calculated by standard meta-analysis techniques with fixed-effects or random-effects models.


RESULTS
21 studies with a total of 9,767 HCC patients stratifying overall survival and/or disease-free survival in HCC patients by diabetes mellitus status were eligible for meta-analysis. 20 studies with a total of 9,727 HCC cases investigated the overall survival, and 10 studies with a total of 2,412 HCC patients investigated the disease-free survival. The pooled HRs for overall survival and disease-free survival were 1.46 (95% CI, 1.29 to 1.66; P<0.001) and 1.57 (95% CI, 1.21 to 2.05; P = 0.001), respectively. The adjusted HRs for overall survival and disease-free survival were 1.55 (95% CI, 1.27 to 1.91; P<0.001) and 2.15 (95% CI, 1.75 to 2.63; P<0.001), respectively. In addition, for patients receiving hepatic resection, diabetes mellitus was associated with both poorer overall survival and poorer disease-free survival, and for patients receiving non-surgical treatment or patients receiving radiofrequency ablation, diabetes mellitus was associated with poorer overall survival. There was no evidence for publication bias.


CONCLUSIONS
Diabetes mellitus is independently associated with both poorer overall survival and poorer disease-free survival in HCC patients.
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Yan-Gang
YG
Wang
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Peng
P
Wang
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Bin
B
Wang
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Zheng-Ju
ZJ
Fu
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Wen-Juan
WJ
Zhao
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
Sheng-Li
SL
Yan
D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality*; D048909:Diabetes Complications / Q000175:diagnosis* / Q000401:mortality; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome