title: Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation.
abstract: OBJECTIVE
  To determine whether diabetes mellitus (DM) affects prognosis/recurrence after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
  
  
  METHODS
  A retrospective study was conducted between January 2000 and August 2013 on 1631 patients with HBV-related HCC who underwent LT with antiviral prophylaxis. Patient data were obtained from the China Liver Transplant Registry (https://www.cltr.org/). To compare the outcomes and tumor recurrence in the HBV-related HCC patients with or without DM, statistical analyses were conducted using χ2tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis.
  
  
  RESULTS
  Univariate analysis of 1631 patients who underwent LT found overall 1-, 3- and 5-year survival rates of 79%, 73% and 71% respectively in the DM patients, and 84%, 78% and 76% in the non-DM patients respectively. Overall survival rate differences after LT between the two groups were significant (P= 0.041), but recurrence-free survival rates were not (P= 0.096). By stratified analysis, the overall survival rates in DM patients for age > 50 years (P= 0.002), the presence of vascular invasion (P= 0.096), tumors ≤ 3 cm (P= 0.047), two to three tumor nodules (P= 0.007), Child-Pugh grade B (P= 0.018), and pre-LT alanine aminotransferase levels between 40 and 80 IU/L (P= 0.017) were significantly lower than in non-DM patients. Additionally, serum α-fetoprotein level > 2000 ng/mL (P= 0.052) was associated with a significant survival difference trend between DM and non-DM patients. Multivariate analysis showed that the presence of DM (P< 0.001, HR = 1.591; 95%CI: 1.239-2.041) was an independent predictor associated with poor survival after LT.
  
  
  CONCLUSIONS
  HBV-related HCC patients with DM have decreased long-term overall survival and poor LT outcomes. Prevention strategies for HCC patients with DM are recommended.
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Yong-Lin
authors.initials: YL
authors.lastname: Deng
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Li-Hong
authors.initials: LH
authors.lastname: Huang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Shang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Xin-Guo
authors.initials: XG
authors.lastname: Chen
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Le-Tian
authors.initials: LT
authors.lastname: Wang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Jin-Zan
authors.initials: JZ
authors.lastname: Du
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Pei-Xiao
authors.initials: PX
authors.lastname: Wang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Qing Zhang, Li-Hong Huang, Xin-Guo Chen, Le-Tian Wan, Jin-Zan Du, Ying Wang, Pei-Xiao Wang, Zhong-Yang Shen, Institute of Liver Transplantation, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.
authors.forename: Zhong-Yang
authors.initials: ZY
authors.lastname: Shen
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Diabetes mellitus; Hepatitis B virus; Hepatocellular carcinoma; Liver transplantation; Survival