Diabetes Worsens the Surgical Outcomes in Cirrhotic Patients with Hepatocellular Carcinoma

Diabetes Worsens the Surgical Outcomes in Cirrhotic Patients with Hepatocellular Carcinoma

CHIN-TSUNG TING,¹ RAN-CHOU CHEN,^2,3,5 CHIEN-CHENG CHEN,¹ MAO-HO LIU,¹ DACHEN CHU⁴ and NAI-WEN KUO⁵

¹Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan
²Department of Biomedical Imaging and Radiological Science, National Yang-Ming University, Taipei, Taiwan
³Department of Radiology, Taipei City Hospital, Taipei, Taiwan
⁴Community Medicine Research Center, Institute of Pubic Health, National Yang-Ming University, Taipei, Taiwan
⁵School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

Diabetes is a known risk factor for developing hepatocellular carcinoma (HCC). Reported rates of diabetes are higher in chronic hepatitis, cirrhosis and HCC patients. However, its effects on postoperative recurrence and survival with HCC are controversial. This study offers a retrospective analysis of the impacts of diabetes on postoperative recurrence and survival in patients with cirrhosis and HCC. A total of 389 cirrhotic patients who underwent curative resection for primary HCC at our institution between January 2000 and December 2008 were enrolled. Of them, 272 (70%) patients were classified into a non-diabetes group and 117 (30%) patients into the diabetes group. The diabetes group was divided into an oral hypoglycemic agent (OHA) control group (n = 100) and an insulin control group (n = 17). The result indicates that the diabetes group had a higher postoperative recurrence rate and poorer long-term survival rate (p = 0.001 vs. 0.01). There was no significant difference in recurrence-free survival rate between the OHA control group and the insulin control group (p = 0.17). The insulin control group had a poorer long-term surgical outcome than the OHA control group (p = 0.035). In conclusion, our results suggest that diabetes is an independent risk factor for postoperative recurrence and surgical survival of cirrhotic HCC patients. Cirrhotic HCC patients with diabetes who received hepatic resection should be closely followed-up for postoperative recurrence and long-term outcome. Moreover, an effective peri-operative sugar control planning in HCC patients with diabetes should be established.

keywords —— diabetes mellitus; hep atocellular carcinoma; insulin; liver cirrhosis; oral hypoglycemic agent

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Tohoku J. Exp. Med., 2012, 227, 73-81

Correspondence: Nai-Wen Kuo, Ph.D., MPH., School of Health Care Administration, Taipei Medical University, 250 Wu-Xing St., Taipei 11031, Taiwan.

e-mail: nwkuo@tmu.edu.tw