Masood Muhammed Adnan, Zafar Waleed, Yusuf Muhammed Aasim
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan,
J Gastrointest Cancer. 2014 Dec;45(4):448-51. doi: 10.1007/s12029-014-9631-x.
There are scarce data regarding the impact of diabetes mellitus on the prognosis of hepatocellular carcinoma managed conservatively. The objective of this study was to compare the overall survival among diabetic and non-diabetic patients suffering from hepatocellular carcinoma and treated mainly by non-surgical means.
We identified patients who underwent treatment for hepatocellular carcinoma over a period of 6.5 years at a single center in Lahore, Pakistan. Data regarding age, gender, morphology of tumor, size of tumor, Child-Pugh class, the Barcelona-Clínic Liver Cancer (BCLC) stage, treatment given, and outcome was retrieved from the medical records. Patients were classified as diabetic if there were at least two documented readings of fasting blood glucose level of more than 126 mg/dl or random blood glucose of more than 200 mg/dl or the patient was already diagnosed and on oral hypoglycemic agents or insulin. Statistical tests were applied to test for differences between diabetic and non-diabetic patients in terms of clinical features at presentation, treatments received, and disease outcomes.
A total of 282 patients were diagnosed as having hepatocellular carcinoma during the study period. Diabetic and non-diabetic patients were comparable in terms of the mean age at diagnosis of hepatocellular carcinoma, sex, whether the tumor was unifocal or multifocal, Child-Pugh class, BCLC stage, and infection with hepatitis B and/or C virus. Diabetic patients were significantly more likely to have initial alpha-feto protein levels lower than 200 IU/ml compared to non-diabetic patients. There was no difference among diabetic and non-diabetic patients in terms of the treatments they received or the outcomes. Non-diabetic and diabetic patients had a mean disease-free survival of 8.29 and 6.95 months, respectively, and overall survival of 15.48 and 15.36 months, respectively. Multivariate linear regression analyses, after adjusting for age and gender of the patient and the BCLC stage of the tumor among the subset of patients documented to have died during the follow-up period, showed that there was no significant difference between diabetic and non-diabetic patients in terms of overall survival. BCLC stage, however, was significantly associated with overall survival.
Diabetes mellitus has no prognostic significance in patients with hepatocellular carcinoma.
关于糖尿病对保守治疗的肝细胞癌预后的影响，相关数据稀缺。本研究的目的是比较主要接受非手术治疗的肝细胞癌糖尿病患者和非糖尿病患者的总生存期。
我们确定了在巴基斯坦拉合尔的一个单一中心接受了6.5年肝细胞癌治疗的患者。从病历中检索有关年龄、性别、肿瘤形态、肿瘤大小、Child-Pugh分级、巴塞罗那临床肝癌（BCLC）分期、所接受的治疗以及结局的数据。如果空腹血糖水平至少有两次记录读数超过126mg/dl或随机血糖超过200mg/dl，或者患者已被诊断并正在服用口服降糖药或胰岛素，则将患者分类为糖尿病患者。应用统计检验来检测糖尿病患者和非糖尿病患者在就诊时的临床特征、接受的治疗以及疾病结局方面的差异。
在研究期间，共有282例患者被诊断为肝细胞癌。糖尿病患者和非糖尿病患者在肝细胞癌诊断时的平均年龄、性别、肿瘤是单灶还是多灶、Child-Pugh分级、BCLC分期以及乙型和/或丙型肝炎病毒感染方面具有可比性。与非糖尿病患者相比，糖尿病患者初始甲胎蛋白水平低于200IU/ml的可能性显著更高。糖尿病患者和非糖尿病患者在接受的治疗或结局方面没有差异。非糖尿病患者和糖尿病患者的平均无病生存期分别为8.29个月和6.95个月，总生存期分别为15.48个月和15.36个月。在对随访期间记录为死亡的患者亚组中，对患者的年龄和性别以及肿瘤的BCLC分期进行调整后，多变量线性回归分析表明，糖尿病患者和非糖尿病患者在总生存期方面没有显著差异。然而，BCLC分期与总生存期显著相关。
糖尿病对肝细胞癌患者没有预后意义。
