title: Diabetes mellitus increases the risk of intrahepatic recurrence of hepatocellular carcinoma after surgical resection.
abstract: OBJECTIVE
  The relationship between cancer and metabolism has recently been receiving attention. We investigated the prognostic influence of type 2 diabetes mellitus in patients with hepatocellular carcinoma (HCC) treated with curative resection.
  
  
  METHODS
  The records of 58 patients who underwent curative resection for HCC pT1-2N0M0 between 2010 and 2014 were reviewed retrospectively. Fourteen patients (24.1%) had diabetes mellitus at diagnosis. Local control (LC) was defined as time to recurrence in the liver.
  
  
  RESULTS
  The median follow-up was 23.3 months. Relapses occurred in 20 patients (34.5%) during the follow-up period; 17 of them developed intrahepatic recurrence, which was associated with diabetes mellitus (p = 0.013) and alpha fetoprotein (AFP) levels >500 ng/mL (p = 0.019). Overall relapses (n = 20) were related to T stage (p = 0.044), AFP level (p = 0.005), and diabetes (p = 0.044). The 3-year local control (intrahepatic control), disease-free survival, and overall survival rates were 56.7%, 50.5%, and 84.3%, respectively. LC was affected by diabetes mellitus (p = 0.046), Barcelona Clinic Liver Cancer staging (p<0.001), Milan criteria for transplantation (p = 0.041), serosal invasion (p = 0.032), and microvascular invasion (p = 0.043). Diabetes was also associated with reduced LC in the subgroup with hepatitis B-related HCC (n = 44, p = 0.028).
  
  
  CONCLUSIONS
  Diabetes mellitus is correlated with intrahepatic HCC recurrence after surgery. Greater attention should be paid to managing patients with HCC and diabetes mellitus.
authors.affiliation: Department of Radiation Oncology, Inje University School of Medicine, Busan Paik Hospital, Busan - Korea.
authors.forename: Yunseon
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of General Surgery, Inje University School of Medicine, Busan Paik Hospital, Busan - Korea.
authors.forename: YoungKil
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of General Surgery, Inje University School of Medicine, Busan Paik Hospital, Busan - Korea.
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Choi
authors.affiliation: Department of Molecular Medicine, College of Medicine, Keimyung University, Daegu - Korea.
authors.forename: Yun-Han
authors.initials: YH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate