Wang Yan-Yan, Huang Shan, Zhong Jian-Hong, Ke Yang, Guo Zhe, Liu Jia-Qi, Ma Liang, Li Hang, Ou Bing-Ning, Li Le-Qun
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
Department of Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
PLoS One. 2014 Dec 1;9(12):e113858. doi: 10.1371/journal.pone.0113858. eCollection 2014.
The influence of diabetes mellitus (DM) on the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. Here we investigated the impact of DM on the prognosis of such patients after curative hepatectomy.
A consecutive cohort of 505 patients with HCC (134 with DM, 371 without) underwent curative hepatectomy were retrospectively evaluated. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS) were compared between patients with or without DM. Independent prognostic predictors were identified using the Cox proportional hazards model.
Patients with or without DM showed similar morbidity and 30- and 90- day mortality after curative hepatectomy (all P>0.05), as well as similar DFS at 1, 3, 5 years (P = 0.781). However, the group of patients with DM showed significantly lower OS at 1, 3, 5 years than the group without DM (P = 0.038). Similar results were obtained in the propensity-matched cohort. Cox multivariate analysis identified DM as an independent predictor of poor OS, but not of poor DFS. We repeat compared OS and DFS for DM and non-DM subgroups defined according to the presence or absence of hepatitis B virus infection and cirrhosis. Similar results were obtained in all subgroups except the non-cirrhotic subgroup which showed patients with and without DM had similar OS.
DM does not significantly affect the postoperative morbidity or mortality or the DFS of patients with HCC after curative hepatectomy. It is, however, associated with significantly lower OS, especially in patients with cirrhosis.
糖尿病（DM）对肝细胞癌（HCC）患者预后的影响仍存在争议。在此，我们研究了DM对根治性肝切除术后此类患者预后的影响。
对连续505例行根治性肝切除的HCC患者（134例合并DM，371例未合并DM）进行回顾性评估。比较合并或未合并DM患者的术后发病率和死亡率、总生存期（OS）和无病生存期（DFS）。使用Cox比例风险模型确定独立的预后预测因素。
合并或未合并DM的患者在根治性肝切除术后的发病率、30天和90天死亡率相似（均P>0.05），1年、3年、5年的DFS也相似（P = 0.781）。然而，合并DM的患者组在1年、3年、5年的OS显著低于未合并DM的患者组（P = 0.038）。倾向匹配队列也得到了类似结果。Cox多因素分析确定DM是OS不良的独立预测因素，但不是DFS不良的独立预测因素。我们再次比较了根据是否存在乙型肝炎病毒感染和肝硬化定义的DM和非DM亚组的OS和DFS。除了非肝硬化亚组显示合并和未合并DM的患者OS相似外，所有亚组均得到类似结果。
DM对根治性肝切除术后HCC患者的术后发病率、死亡率或DFS无显著影响。然而，它与显著较低的OS相关，尤其是在肝硬化患者中。
