The influence of postoperative glycemic control on recurrence after curative resection in diabetics with hepatitis C virus‐related hepatocellular carcinoma

Kaneda, Kazuhisa; Uenishi, Takahiro; Takemura, Shigekazu; Shinkawa, Hiroji; Urata, Yoshishige; Sakae, Masayuki; Yamamoto, Takatsugu; Kubo, Shoji

doi:10.1002/jso.22137

Cited by 18 publications

(17 citation statements)

References 40 publications

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“…In addition to preoperative glycemic control, poor glycemic control (HbA1c ≥6.5%) after surgery was associated with postoperative tumor recurrence in diabetic patients. 19 Consistent with the previous report, the overall survival period in patients in the normal HbA1c group tended to be longer than in the high HbA1c group, whereas the periods of recurrence-free survival were not significantly different between the two groups in this series. These data indicate that postoperative glycemic control is important to achieve a favorable outcome in diabetic patients with HCC.…”

Section: Discussionsupporting

confidence: 92%

“…To maintain the postoperative HbA1c level <6.5%, patients received oral hyperglycemic drugs or insulin therapy. Postoperative HbA1c levels were measured every 3 months during the follow‐up period for HCC recurrence, and the mean of these values was evaluated . Patients with postoperative HbA1c level <6.5% comprised the normal HbA1c group; those with a level ≥6.5% were classified as the high HbA1c group.…”

Section: Methodsmentioning

confidence: 99%

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Diabetes mellitus not an unfavorable factor on the prognosis of hepatitis C virus‐related hepatocellular carcinoma

Yoshida

Midorikawa

Higaki

et al. 2017

Hepatology Research

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Aim: Diabetes mellitus (DM) is a potential risk factor for hepatocarcinogenesis, especially in patients with hepatitis C virus (HCV) infection. We aimed to elucidate whether DM influences the surgical outcomes of patients with hepatocellular carcinoma (HCC).Methods: Our patients were routinely controlled to keep urinary glucose excretion to less than 3.0 g/day before surgery, and the serum glucose level under 200 mg/dL after surgery. The surgical outcomes and postoperative complications of 112 patients with HCV-related HCC with DM (DM group) were compared to those of 112 propensity-matched patients without DM (non-DM group).Results: After a median follow-up of 3.2 years (range, 0.2-11.3 years), the median overall (5.2 years; 95% confidence interval, 3.8-6.5 years) and recurrence-free survival (2.2 years; 1.7-2.9 years) in the DM group were not significantly different from those (6.3 years; 5.4-7.1 years, P = 0.337; and 2.2 years; 1.7-3.6 years, P = 0.613) in the non-DM group. The independent factors related to overall survival were the background liver (hazard ratio, 2.06; 95% confidence interval, 1.27-3.39, P = 0.014) and tumor differentiation grade (2.07; 1.14-4.05, P = 0.015). Thirty-two patients (28.5%) in the DM group and 32 patients (28.5%) in the non-DM group had morbidities after operation, with no significant difference between the groups (P = 1.000). Furthermore, postoperative control status of DM did not affect the prognostic outcome.Conclusion: Diabetes mellitus does not affect the surgical outcomes of patients with HCV-related HCC, and it is not an unfavorable factor when selecting candidates for liver resection of HCC.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Diabetes mellitus not an unfavorable factor on the prognosis of hepatitis C virus‐related hepatocellular carcinoma

Yoshida

Midorikawa

Higaki

et al. 2017

Hepatology Research

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“…Kaneda et al (2012) found a large risk (HR=3.551, P =0.03) for HCC recurrence as the HbA 1c level increased above 6.5% for patients with diabetes. Donadon et al (2010) found that the OR for HCC increased by 1.508 for each percentage increase in HbA 1c for type 2 diabetic patients compared with controls with liver cirrhosis ( P =0.0005).…”

Section: Resultsmentioning

confidence: 94%

“…Two studies that were excluded from the quantitative analysis as they did not provide enough HbA 1c levels (Donadon et al , 2010; Kaneda et al , 2012) found changes in hepatocellular carcinoma (HCC) risk as HbA 1c increased. Kaneda et al (2012) found a large risk (HR=3.551, P =0.03) for HCC recurrence as the HbA 1c level increased above 6.5% for patients with diabetes.…”

Section: Resultsmentioning

confidence: 99%

Does cancer risk increase with HbA1c, independent of diabetes?

2014

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Background:The risks for several cancer types are increased in people with diabetes. Hyperglycaemia, hyperinsulinaemia, inflammation and altered hormonal concentrations are common characteristics between the two diseases and can all be linked to hyperglycaemia.Methods:Here, we use glycated haemoglobin (HbA1c) as a biomarker for chronic hyperglycaemia. We explore whether cancer risk increases with HbA1c, independent of diabetes, and, therefore, if risk is already increased below the diabetic HbA1c range, by analysing data from current studies linking HbA1c to risk of several cancer types.Results:The data reveal that chronic hyperglycaemia correlates with increased cancer risk for a number of cancers, except prostate cancer. Evidence is also provided that risk is already increased in the pre-diabetic and normal ranges for several cancers.Conclusions:These results merit urgent investigation into the risks and advantages of updating recommendations for stricter glycaemic control in diabetic and non-diabetic subjects, as this could help reduce the risk of cancer incidence and mortality.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Deng

Liu

et al. 2016

WJG

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AIMTo determine whether diabetes mellitus (DM) affects prognosis/recurrence after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).METHODSA 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 χ2 tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis.RESULTSUnivariate 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.CONCLUSIONHBV-related HCC patients with DM have decreased long-term overall survival and poor LT outcomes. Prevention strategies for HCC patients with DM are recommended.

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The influence of postoperative glycemic control on recurrence after curative resection in diabetics with hepatitis C virus‐related hepatocellular carcinoma

Abstract: Careful control of plasma glucose should be performed to prevent tumor recurrence after curative resection for HCV-related HCC in patients with diabetes.

Cited by 18 publications

References 40 publications

Diabetes mellitus not an unfavorable factor on the prognosis of hepatitis C virus‐related hepatocellular carcinoma

Diabetes mellitus not an unfavorable factor on the prognosis of hepatitis C virus‐related hepatocellular carcinoma

Does cancer risk increase with HbA1c, independent of diabetes?

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

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