Shinkawa Hiroji, Kaibori Masaki, Ueno Masaki, Yasuda Satoshi, Ikoma Hisashi, Aihara Tsukasa, Nakai Takuya, Kinoshita Masahiko, Kosaka Hisashi, Hayami Shinya, Matsuo Yasuko, Morimura Ryo, Nakajima Takayoshi, Nobori Chihoko, Ishizawa Takeaki
Department of Hepatobiliary Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Japan.
Liver Cancer. 2024 Aug 20;14(1):80-91. doi: 10.1159/000540858. eCollection 2025 Mar.
This study aimed to evaluate the association of obesity and diabetes mellitus (DM) comorbidity with hepatocellular carcinoma (HCC) recurrence and survival.
We investigated 1,644 patients who underwent hepatic resection for solitary HCC without vascular invasion using computed tomography. Patients were categorized into four groups according to the combination of obesity and DM comorbidities: OB (+) or (-) and DM (+) or (-). Postoperative cumulative recurrence rates within and beyond 2 years and beyond 5 years were assessed.
Multivariate Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (HRs) of reduced recurrence-free survival was 1.10 (95% confidence interval [CI]: 0.91-1.33; = 0.31), 0.94 (95% CI: 0.78-1.12; = 0.48), and 1.24 (95% CI: 1.01-1.54; = 0.045) in the OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups compared with the OB(-)DM(-) group, respectively. Additionally, the corresponding adjusted HRs of reduced overall survival were 0.93 ( = 0.57), 0.97 ( = 0.76), and 1.38 ( = 0.013) for OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups, respectively. No significant difference in the early recurrence rate was determined among the four groups. The OB(+)DM(+) group demonstrated an increased risk for late recurrence beyond 2 years and 5 years postoperatively compared with the OB(-)DM(-) group (HR: 1.51; = 0.024 and HR: 2.53; = 0.046, respectively). The OB(+)DM(-) and OB(-)DM(+) groups demonstrated an increased risk for late recurrence beyond 5 years postoperatively (HR: 3.83; < 0.001 and HR: 1.95; = 0.037, respectively).
Obesity and DM coexistence increased late recurrence and worsened prognosis in patients with HCC undergoing hepatic resection. The results help surgeons develop possible different surveillance protocol and need to focus on diabetes/obesity control during life-long surveillance for patients with HCC.
本研究旨在评估肥胖与糖尿病（DM）合并症与肝细胞癌（HCC）复发及生存的相关性。
我们对1644例接受了无血管侵犯的孤立性HCC肝切除术的患者进行了计算机断层扫描调查。根据肥胖和DM合并症的组合将患者分为四组：肥胖（+）或（-）以及DM（+）或（-）。评估术后2年内、2年以上及5年以上的累积复发率。
多因素Cox比例风险回归分析显示，与肥胖（-）DM（-）组相比，肥胖（+）DM（-）、肥胖（-）DM（+）和肥胖（+）DM（+）组无复发生存期缩短的调整后风险比（HR）分别为1.10（95%置信区间[CI]：0.91 - 1.33；P = 0.31）、0.94（95%CI：0.78 - 1.12；P = 0.48）和1.24（95%CI：1.01 - 1.54；P = 0.045）。此外，肥胖（+）DM（-）、肥胖（-）DM（+）和肥胖（+）DM（+）组总生存期缩短的相应调整后HR分别为0.93（P = 0.57）、0.97（P = 0.76）和1.38（P = 0.013）。四组之间早期复发率无显著差异。与肥胖（-）DM（-）组相比，肥胖（+）DM（+）组术后2年和5年以上晚期复发风险增加（HR分别为1.51；P = 0.024和HR为2.53；P = 0.046）。肥胖（+）DM（-）和肥胖（-）DM（+）组术后5年以上晚期复发风险增加（HR分别为3.83；P < 0.001和HR为1.95；P = 0.037）。
肥胖与DM共存会增加接受肝切除术的HCC患者的晚期复发率并恶化预后。这些结果有助于外科医生制定可能不同的监测方案，并且在对HCC患者进行终身监测期间需要关注糖尿病/肥胖的控制。
