Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9571
Peer-review started: June 17, 2016
First decision: July 12, 2016
Revised: August 2, 2016
Accepted: September 14, 2016
Article in press: September 14, 2016
Published online: November 21, 2016
Processing time: 160 Days and 2 Hours
To determine whether diabetes mellitus (DM) affects prognosis/recurrence after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
A retrospective study was conducted between January 2000 and August 2013 on 1631 patients with HBV-related HCC who underwent LT with antiviral prophylaxis. Patient data were obtained from the China Liver Transplant Registry (https://www.cltr.org/). To compare the outcomes and tumor recurrence in the HBV-related HCC patients with or without DM, statistical analyses were conducted using χ2 tests, Mann-Whitney tests, the Kaplan-Meier method, log-rank tests and multivariate step-wise Cox regression analysis.
Univariate analysis of 1631 patients who underwent LT found overall 1-, 3- and 5-year survival rates of 79%, 73% and 71% respectively in the DM patients, and 84%, 78% and 76% in the non-DM patients respectively. Overall survival rate differences after LT between the two groups were significant (P = 0.041), but recurrence-free survival rates were not (P = 0.096). By stratified analysis, the overall survival rates in DM patients for age > 50 years (P = 0.002), the presence of vascular invasion (P = 0.096), tumors ≤ 3 cm (P = 0.047), two to three tumor nodules (P = 0.007), Child-Pugh grade B (P = 0.018), and pre-LT alanine aminotransferase levels between 40 and 80 IU/L (P = 0.017) were significantly lower than in non-DM patients. Additionally, serum α-fetoprotein level > 2000 ng/mL (P = 0.052) was associated with a significant survival difference trend between DM and non-DM patients. Multivariate analysis showed that the presence of DM (P < 0.001, HR = 1.591; 95%CI: 1.239-2.041) was an independent predictor associated with poor survival after LT.
HBV-related HCC patients with DM have decreased long-term overall survival and poor LT outcomes. Prevention strategies for HCC patients with DM are recommended.
Core tip: Diabetes mellitus (DM) may be associated with hepatocellular carcinoma (HCC) pathological features, old age and poor liver function, which may influence post-liver transplantation (LT) survival in hepatitis B virus (HBV)-related HCC patients. However, no direct relation between DM and HBV infection or HBV load were observed in HCC patients. The current data represent a multi-center study involving a larger number of samples, and suggest that DM may affect the long-term post-LT survival of HBV-related HCC patients, but not of tumor recurrence. Thus, HCC patients with DM undergoing LT should be closely followed to optimize outcomes. Follow-up examinations are especially important among DM patients who are elderly or who have the presence of vascular invasion and serum α-fetoprotein levels > 2000 ng/mL pre-LT.