Concurrent hyperglycemia does not influence the long-term prognosis of unresectable hepatocellular carcinomas

The prognostic role of diabetes mellitus type 2 in the setting of hepatocellular carcinoma: a systematic review and meta-analysis

AIM

To evaluate the effect of diabetes mellitus type 2 (T2DM) on the outcomes after treatment of hepatocellular carcinoma (HCC).

METHODS

PubMed and Cochrane Central Register of Controlled Trials Databases were systematically searched. Three HCC clinical outcomes were explored: death, progressive disease after locoregional therapies, and recurrence. Sub-analysis was performed according to the use of potentially curative (resection, transplantation, termo-ablation) or non-curative therapies. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare the pooled data between T2DM and non-T2DM groups.

RESULTS

A total of 27 studies were analyzed. Overall, 85.2% of articles were from Asia. T2MD was associated with an increased risk of death (OR 3.60; 95%CI 2.18-5.95; P<0.001), irrespective of the treatment approach: curative (OR 1.30 95%CI 1.09-1.54; P=0.003) or non-curative (OR 1.05; 95%CI 1.00-1.10; P=0.045), increased HCC recurrence (OR 1.30; 95%CI 1.03-1.63; P=0.03), and increased disease progressiveness (OR 1.24; 95%CI 1.09-1.41; P=0.001).

CONCLUSIONS

Current data provide strong evidence that T2DM unfavorably affects HCC progression and recurrence, and patients' survival after treatment, irrespective of the approach used.

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.

Conclusion

Diabetes mellitus is independently associated with both poorer overall survival and poorer disease-free survival in HCC patients.

Application of an end-stage liver disease model in prediction of prognosis in patients with liver cirrhosis

AIM: To evaluate the short- and medium-term prognosis of liver cirrhotic patients by using the model for end-stage liver disease (MELD).

METHODS: The data of 199 cirrhotic patients were analyzed with a cohort method retrospectively and the follow-up period was at least one year. Both MELD score and Child-Pugh score were computed for each patient according to the original formula on admission day. Area under of receiver operating characteristic curve (ROC) was used to compare the value of MELD score with Child-Pugh's for predicting the prognosis. Kaplan-Meier survival curves were made using the cut-offs identified by means of ROC. MELD values were correlated with Child-Pugh scores.

RESULTS: Thirty-seven patients died in three months, MELD scores and Child-Pugh scores for non-survivors (23.4± 9.90, 10.8±2.29) were higher than those for survivors (14.3± 4.66, 8.68±2.21) significantly (P < 0.001). Fifty-nine patients died within the first year, MELD scores and Child-Pugh scores for non-survivors (20.3±9.31, 10.3±2.32) were higher than those for survivors (14.0±5.11, 8.43±2.23) significantly (P < 0.001). Area under the ROC of MELD for 3 months (0.826) was significantly (P < 0.05) different from that of Child-Pugh (0.745), but there was no difference in area under the ROC for 1 year (P > 0.05) between MELD value (0.758) and Child-Pugh score (0.724). Survival curves showed both MELD and Child-Pugh scores was clearly discriminated between patients who survived and those who died in short term as well as in the medium term (P < 0.001). MELD grading system showed significant correlation with Child-Pugh scores (r = 0.69, P < 0.001).

CONCLUSION: MELD grading is an objective predictive system for both short- and medium- term survival. It is more efficient than Child-Pugh score for short-term prognosis and is worth using in clinical setting.