Differential mechanism and prognostic impact of diabetes mellitus on patients with hepatocellular carcinoma undergoing surgical and nonsurgical treatment.

OBJECTIVES: Diabetes mellitus (DM) is prevalent in patients with hepatocellular carcinoma (HCC) due to coexisting cirrhosis. This study aimed to investigate the long-term impact of DM on HCC patients and its underlying mechanism.
METHODS: A total of 567 (120 diabetic) HCC patients were included. The survival was compared between patients with and without DM according to the treatment modality. The occurrence of hepatic decompensation was defined as the sustained increment of the Child-Pugh score by 2 points or more during the follow-up period.
RESULTS: Survival analysis showed that DM was not a significant prognostic predictor among the 255 (41 diabetic, 16%) patients who underwent resection (p= 0.155). However, DM was a poor prognostic predictor among those with small (< or = 5 cm) HCC (n = 159; relative risk [RR]: 2.3, 95% confidence interval [CI]: 1.2-5.1, p= 0.021) or those without postoperative tumor recurrence (n = 133; RR: 2.1, 95% CI: 1.2-4.8, p= 0.032) due to the occurrence of more diabetes-related deaths. Of the 312 (79 diabetic, 25%) patients who underwent nonsurgical treatment including transarterial chemoembolization and percutaneous injection, DM was a poor prognostic predictor among those with Child-Pugh A reserve (n = 222; RR: 1.6, 95% CI: 1.1-2.5, p= 0.044). Diabetic patients were more susceptible to develop hepatic decompensation in this group (RR: 1.7, 95% CI: 1.1-2.6, p= 0.012).
CONCLUSIONS: There is a selective mechanism and prognostic impact of DM on HCC patients undergoing surgical and nonsurgical therapy. DM may affect the long-term survival through diabetes-related complications or inducing liver failure depending on treatment strategy and under the influence of tumoral and cirrhosis factors. Copyright 2004 American College of Gastroenterology