Guanghua Liu1, Fang Xia2, Guoping Fan3, Juming Yu4, Lei Bao5, Caiyuan Zhang6, Runmin Chi7, Tingting Zhang8, Lijun Wang9, Feng Shen10, Dengbin Wang11. 1. Department of Interventional Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: liuguanghua@xinhuamed.com.cn. 2. Department of Cardiology, Dahua Hospital, Xuhui District, Shanghai, China. Electronic address: xiaoyu7258@hotmail.com. 3. Department of Interventional Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: fanguoping@aliyun.com. 4. Department of Interventional Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: jmingyu@hotmail.com. 5. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: mrbaozi@163.com. 6. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: williammendyethan@163.com. 7. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: chirunmin@126.com. 8. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: zhangtingting@xinhuamed.com.cn. 9. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: wangjun.124@163.com. 10. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: shenfengehbh@sina.com. 11. Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: wangdengbin@xinhuamed.com.cn.
Abstract
AIMS: The aim of this study was to investigate the impact of type 2 diabetes mellitus (T2DM) on the prognosis of hepatocellular carcinoma (HCC) patients following transarterial chemoembolization (TACE). METHODS: Time to progression (TTP) and cancer-specific mortality (CSM) in competing risk model were compared in patients with (n = 289) or without (n = 763) T2DM. Propensity score matching (PSM) was used to reduce bias between the two groups. Multivariate competing risk regression was used to evaluate independent risk factors for TTP and CSM. RESULTS: The T2DM group showed significantly worse 5-year TTP and CSM rates than the non-T2DM group both in the whole cohort (n = 1052) and the PSM cohort (n = 514) (81.3% vs. 70.9%, P < 0.001, and 61.5% vs. 49.3%, P = 0.006; 81.4% vs. 68.6%, P = 0.003, and 61.7% vs. 43.2%, P = 0.014, respectively). Multivariate competing risk regression identified T2DM as an independent risk factor for TTP and CSM before and after PSM (hazard ratio: 1.37 [95% confidence interval: 1.07-1.77] and 1.36 [1.05-1.75]; 1.29 [1.04-1.60] and 1.24 [1.02-1.52], respectively). T2DM worsened the long-term outcomes of patients in the cirrhosis subgroup but not those in the noncirrhosis subgroup. CONCLUSIONS: T2DM worsened the long-term survival of intermediate-stage HCC patients who underwent TACE, especially in patients with cirrhosis.
AIMS: The aim of this study was to investigate the impact of type 2 diabetes mellitus (T2DM) on the prognosis of hepatocellular carcinoma (HCC) patients following transarterial chemoembolization (TACE). METHODS: Time to progression (TTP) and cancer-specific mortality (CSM) in competing risk model were compared in patients with (n = 289) or without (n = 763) T2DM. Propensity score matching (PSM) was used to reduce bias between the two groups. Multivariate competing risk regression was used to evaluate independent risk factors for TTP and CSM. RESULTS: The T2DM group showed significantly worse 5-year TTP and CSM rates than the non-T2DM group both in the whole cohort (n = 1052) and the PSM cohort (n = 514) (81.3% vs. 70.9%, P < 0.001, and 61.5% vs. 49.3%, P = 0.006; 81.4% vs. 68.6%, P = 0.003, and 61.7% vs. 43.2%, P = 0.014, respectively). Multivariate competing risk regression identified T2DM as an independent risk factor for TTP and CSM before and after PSM (hazard ratio: 1.37 [95% confidence interval: 1.07-1.77] and 1.36 [1.05-1.75]; 1.29 [1.04-1.60] and 1.24 [1.02-1.52], respectively). T2DM worsened the long-term outcomes of patients in the cirrhosis subgroup but not those in the noncirrhosis subgroup. CONCLUSIONS: T2DM worsened the long-term survival of intermediate-stage HCCpatients who underwent TACE, especially in patients with cirrhosis.