Liu Shi-Rong, Chao Ren, Liang Ping, Yu Xiao-Ling, Cheng Zhi-Gang, Han Zhi-Yu
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
J BUON. 2018 Jul-Aug;23(4):958-964.
This study aimed to investigate the outcomes of hepatocellular carcinoma (HCC) patients after curative microwave ablation (MWA) with and without diabetes mellitus (DM).
A total of 308 patients with HCC were retrospectively studied from 2005 to 2012 over an 8-year period. They were all successfully treated by MWA. Progression-free survival (PFS) and overall survival (OS) were analyzed according to the status of DM. The presence of other comorbidities and tumor status were studied using multivariate analysis.
Significant differences were observed both for 1-, 3-, 5- year's PFS rates (DM: 63.8, 23.0 and 15.8 vs non-DM: 72.7, 43.6 and 30.8%; p=0.013) and OS rates (DM: 87.3, 75.1 and 49.5% vs non-DM: 97.9, 82.9 and 70.5%; p=0.045) between patients with and without DM. Cox multivariate analysis identified the following factors significantly associated with PFS: (hazard ration (HR): 1.191, 95% CI: 1.051-1,349, p=0.006), AFP (HR:1.000, 95% CI: 1.000-1.000, p=0.022), alcohol abuse (>100g/d vs ≤100g/d, HR:1.579, 95% CI:1.128- 2.212, p=0.008), mean fasting plasma glucose level after initial therapy for HCC(>7.0 / ≤7.0, HR:2.728, 95%CI:1.414- 5.265, p=0.003); and the followings associated with OS:Child-Pugh classification A against B, C (risk 1.692, 95%CI 1.065-2.689, P=0.026), tumor diameter (risk 1.251. 95% CI 1.021-1.534, P=0.031), and AFP (risk 1.000. 95% CI 1.000- 1.000, P=0.000).
DM may affect the HCC progression and overall survival in patients undergoing curative MWA. A good control of the glucose levels after ablation may be important for improving the prognosis of HCC.
本研究旨在调查肝细胞癌（HCC）患者在接受有或无糖尿病（DM）的根治性微波消融（MWA）后的结局。
回顾性研究了2005年至2012年期间共308例HCC患者，为期8年。他们均成功接受了MWA治疗。根据DM状态分析无进展生存期（PFS）和总生存期（OS）。使用多变量分析研究其他合并症的存在情况和肿瘤状态。
观察到DM患者和非DM患者在1年、3年、5年的PFS率（DM：63.8%、23.0%和15.8%，非DM：72.7%、43.6%和30.8%；p = 0.013）和OS率（DM：87.3%、75.1%和49.5%，非DM：97.9%、82.9%和70.5%；p = 0.045）方面存在显著差异。Cox多变量分析确定以下因素与PFS显著相关：（风险比（HR）：1.191，95%置信区间：1.051 - 1.349，p = 0.006），甲胎蛋白（AFP）（HR：1.000，95%置信区间：1.000 - 1.000，p = 0.022），酗酒（>100克/天与≤100克/天，HR：1.579，95%置信区间：1.128 - 2.212，p = 0.008），HCC初始治疗后的平均空腹血糖水平（>7.0/≤7.0，HR：2.728，95%置信区间：1.414 - 5.265，p = 0.003）；以及与OS相关的以下因素：Child-Pugh分级A与B、C相比（风险1.692，95%置信区间1.065 - 2.689，P = 0.026），肿瘤直径（风险1.251，95%置信区间1.021 - 1.534，P = 0.031），以及AFP（风险1.000，95%置信区间1.000 - 1.000，P = 0.000）。
DM可能影响接受根治性MWA的HCC患者的病情进展和总生存期。消融后良好控制血糖水平可能对改善HCC的预后很重要。
