糖尿病与肝细胞癌预后较差：一项系统评价与荟萃分析
Diabetes mellitus and poorer prognosis in hepatocellular carcinoma: a systematic review and meta-analysis.
作者信息
Wang Yan-Gang, Wang Peng, Wang Bin, Fu Zheng-Ju, Zhao Wen-Juan, Yan Sheng-Li
机构信息
Department of Endocrinology, the Affiliated Hospital of Medical College, Qingdao University, Qingdao, China.
出版信息
PLoS One. 2014 May 15;9(5):e95485. doi: 10.1371/journal.pone.0095485. eCollection 2014.
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.
背景
既往研究提示糖尿病与癌症风险及预后相关，但关于糖尿病与肝细胞癌（HCC）患者生存关系的研究结果并不一致。为更精确地评估糖尿病在HCC中的预后作用，我们系统回顾了已发表的研究并进行了荟萃分析。
方法
从电子数据库建库至2013年9月16日筛选符合条件的文章。为评估糖尿病与HCC预后的相关性，采用固定效应或随机效应模型的标准荟萃分析技术计算总体生存和无病生存较差时的合并风险比（HR）及其95%置信区间（95%CI）。
结果
21项研究共9767例HCC患者根据糖尿病状态对HCC患者的总体生存和/或无病生存进行分层，符合荟萃分析条件。20项研究共9727例HCC病例调查了总体生存情况，10项研究共2412例HCC患者调查了无病生存情况。总体生存和无病生存的合并HR分别为1.46（95%CI，1.29至1.66；P<0.001）和1.57（95%CI，1.21至2.05；P = 0.001）。总体生存和无病生存的校正HR分别为1.55（95%CI，1.27至1.91；P<0.001）和2.15（95%CI，1.75至2.63；P<0.001）。此外，对于接受肝切除的患者，糖尿病与较差的总体生存和无病生存均相关；对于接受非手术治疗或接受射频消融的患者，糖尿病与较差的总体生存相关。没有证据表明存在发表偏倚。
结论
糖尿病与HCC患者较差的总体生存和无病生存均独立相关。
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