Diabetes mellitus impacts risk of macrovascular invasion in patients undergoing transplantation for hepatocellular carcinoma

Abstract

BackgroundDiabetes mellitus (DM) is identified as a negative prognostic indicator in hepatocellular carcinoma (HCC), though the basis for this is unknown.MethodsThis is a retrospective analysis of a prospectively collected database of 191 HCC patients treated at the University of Rochester Medical Center (URMC) with orthotopic liver transplantation between 1998–2008. Clinical characteristics were compared between patients with and without DM prior to liver transplantation and logistic regression analyses were conducted to assess the effect of DM on clinical outcomes including vascular invasion.ResultsEighty-four of 191 (44%) transplanted patients had DM at time of transplantation. An association of DM with invasive disease was found among transplanted HCC patients where histologically confirmed macrovascular invasion was found in 20.2% (17/84) of diabetics compared to 9.3% of non-diabetics (10/107) (p=0.032). This difference also remained significant when adjusting for tumor size, number of nodules, age, obesity and etiologic risk factors in multivariate logistic regression analysis (OR=3.2, p=0.025).ConclusionsDM is associated with macrovascular invasion among a cohort of transplanted HCC patients.

Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation

“…Multivariate analysis also indicated that DM was a significant independent predictor of poor survival, but not of HCC recurrence post-LT. This finding is consistent with previous studies that reported decreased post-operative survival rates in HCC patients with DM[23,24,29-32]. …”

“…To our knowledge, only two studies have compared the impact of pre-LT DM on survival and tumor recurrence in HCC patients after LT[23,24]. Connolly et al[23] studied 191 LT-treated HCC patients (12 HBV-related, 104 HCV-related and 81 other HCCs) and determined that the median survival was 78.3 mo for the non-DM patients, but only 31.1 mo for the DM patients.…”

“…Connolly et al[23] studied 191 LT-treated HCC patients (12 HBV-related, 104 HCV-related and 81 other HCCs) and determined that the median survival was 78.3 mo for the non-DM patients, but only 31.1 mo for the DM patients. However, no significant differences were observed in survival between the two groups.…”

“…They reported that DM patients had worse overall survival than those without diabetes. The reason for the different outcomes in these studies is not clear, but the differences may be partly attributable to the smaller patient populations with HBV-related HCC in the Connolly et al[23] study. Nonetheless, both studies determined that there was no difference in tumor recurrence between DM and non-DM patients.…”

“…Some studies have suggested that DM increases the risk of HCC recurrence and poor patient outcomes in patients undergoing hepatic resection[22]. However, other studies reported that DM does not worsen the prognosis of HCC patients after resection[23,24]. Few studies have investigated the association between HBV, DM, tumor recurrence and long-term survival of HCC patients who underwent LT.…”