J Gastrointest Canc (2014) 45:448–451 DOI 10.1007/s12029-014-9631-x
ORIGINAL RESEARCH
Is Diabetes Mellitus a Poor Prognostic Factor for Hepatocellular Carcinoma? Muhammed Adnan Masood & Waleed Zafar & Muhammed Aasim Yusuf
Published online: 25 June 2014 # Springer Science+Business Media New York 2014
Abstract Background 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. Methods 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. Results 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 M. A. Masood (*) : W. Zafar : M. A. Yusuf Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan e-mail: [email protected]
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. Conclusion Diabetes mellitus has no prognostic significance in patients with hepatocellular carcinoma. Keywords Hepatocellular carcinoma . Prognosis . Diabetes mellitus . Non-surgical treatment
Background Hepatocellular carcinoma is one of the leading causes of morbidity and mortality worldwide [1]. Its burden is rising because of increasing alcohol consumption, non-alcoholic steatohepatitis, and most importantly, chronic viral hepatitis [2]. Diabetes is considered to be a risk factor for hepatocellular carcinoma and is prevalent in both developed and developing countries [3]. Multiple mechanisms are proposed to explain this association but none has, as yet, been proven [4]. The prognostic significance of diabetes mellitus, if any, in hepatocellular carcinoma has been the subject of ongoing debate for more than a decade. A few studies, with conflicting results, have been published and most of these were carried out in patients who underwent hepatic resection [5–7]. The aim of our study was to assess whether the presence of diabetes mellitus affected the overall survival among those patients who had hepatocellular carcinoma and were managed by non-surgical means.
J Gastrointest Canc (2014) 45:448–451
according to the recommendations of the MDT and the institutional guidelines. This study was approved by the institutional review board of SKMCH&RC.
Methods Study Settings and Population We conducted a retrospective chart review of all patients treated for hepatocellular carcinoma between June, 2006, and December, 2012, at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan. SKMCH&RC is a private tertiary-care non-profit hospital that specializes in the management of cancer patients. Since a majority of the patients treated at this hospital receive some form of financial support from the charitable trust that owns and governs the hospital, the hospital only accepts for treatment patients that meet certain eligibility criteria. For patients with a hepatocellular mass, the eligibility criteria are that they should be treatment-naïve with a malignancy confirmed by imaging or histology and a disease stage of III or lower. For inclusion in this study, all patients were diagnosed as having hepatocellular carcinoma on the basis of typical radiological features on bi-/tri-phasic CT or dynamic MRI scan, i.e., arterial uptake and delayed venous phase washout. If both the radiological investigations were inconclusive, then the diagnosis was confirmed histologically. All included patients were adults (18 years or above). All patients were discussed in the weekly multidisciplinary team (MDT) meeting and treated
Table 1 Demographic characteristics Age; mean (SD)
BCLC Barcelona-Clinic Liver Cancer staging system
449
Sex; n (%) Male Female Lesion; n (%) Unifocal Multifocal Tumor size (in cm); mean (SD) Child-Pugh stage; n (%) A B C BCLC stage; n (%) A B C D Comorbidity; n (%) Hepatitis B positive only Hepatitis C positive only Both hepatitis B and C positive Alpha-feto protein levels; n (%)
ORIGINAL RESEARCH
Is Diabetes Mellitus a Poor Prognostic Factor for Hepatocellular Carcinoma? Muhammed Adnan Masood & Waleed Zafar & Muhammed Aasim Yusuf
Published online: 25 June 2014 # Springer Science+Business Media New York 2014
Abstract Background 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. Methods 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. Results 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 M. A. Masood (*) : W. Zafar : M. A. Yusuf Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan e-mail: [email protected]
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. Conclusion Diabetes mellitus has no prognostic significance in patients with hepatocellular carcinoma. Keywords Hepatocellular carcinoma . Prognosis . Diabetes mellitus . Non-surgical treatment
Background Hepatocellular carcinoma is one of the leading causes of morbidity and mortality worldwide [1]. Its burden is rising because of increasing alcohol consumption, non-alcoholic steatohepatitis, and most importantly, chronic viral hepatitis [2]. Diabetes is considered to be a risk factor for hepatocellular carcinoma and is prevalent in both developed and developing countries [3]. Multiple mechanisms are proposed to explain this association but none has, as yet, been proven [4]. The prognostic significance of diabetes mellitus, if any, in hepatocellular carcinoma has been the subject of ongoing debate for more than a decade. A few studies, with conflicting results, have been published and most of these were carried out in patients who underwent hepatic resection [5–7]. The aim of our study was to assess whether the presence of diabetes mellitus affected the overall survival among those patients who had hepatocellular carcinoma and were managed by non-surgical means.
J Gastrointest Canc (2014) 45:448–451
according to the recommendations of the MDT and the institutional guidelines. This study was approved by the institutional review board of SKMCH&RC.
Methods Study Settings and Population We conducted a retrospective chart review of all patients treated for hepatocellular carcinoma between June, 2006, and December, 2012, at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan. SKMCH&RC is a private tertiary-care non-profit hospital that specializes in the management of cancer patients. Since a majority of the patients treated at this hospital receive some form of financial support from the charitable trust that owns and governs the hospital, the hospital only accepts for treatment patients that meet certain eligibility criteria. For patients with a hepatocellular mass, the eligibility criteria are that they should be treatment-naïve with a malignancy confirmed by imaging or histology and a disease stage of III or lower. For inclusion in this study, all patients were diagnosed as having hepatocellular carcinoma on the basis of typical radiological features on bi-/tri-phasic CT or dynamic MRI scan, i.e., arterial uptake and delayed venous phase washout. If both the radiological investigations were inconclusive, then the diagnosis was confirmed histologically. All included patients were adults (18 years or above). All patients were discussed in the weekly multidisciplinary team (MDT) meeting and treated
Table 1 Demographic characteristics Age; mean (SD)
BCLC Barcelona-Clinic Liver Cancer staging system
449
Sex; n (%) Male Female Lesion; n (%) Unifocal Multifocal Tumor size (in cm); mean (SD) Child-Pugh stage; n (%) A B C BCLC stage; n (%) A B C D Comorbidity; n (%) Hepatitis B positive only Hepatitis C positive only Both hepatitis B and C positive Alpha-feto protein levels; n (%)
