Clinics and Research in Hepatology and Gastroenterology
Original articleType 2 Diabetes does not worsen prognosis in hepatocellular carcinoma
Introduction
Hepatocellular carcinoma (HCC) is an important major public health issue, with the incidence and mortality increasing in all areas of the world, including Europe, Japan, USA and Australia [1]. Worldwide, it is the fourth most common cancer and third most common cause of cancer-related death [2]. Survival is poor, reflecting the aggressive nature of HCC, frequency of late diagnosis and availability of limited treatment options for advanced disease [3]. Ablative treatments with alcohol, radiofrequency ablation (RFA) or transarterial chemoembolisation (TACE) have been demonstrated to control progression of disease and in some studies improve survival [4], [5], [6].
Type 2 diabetes (T2DM) is relatively common in patients with cirrhosis and its role in fibrosis progression in NASH related cirrhosis is an area of active research. T2DM is a risk factor for all cancer types, including HCC [7], [8]. However, the impact of T2DM on the natural history of HCC is not known. With the current global epidemic of the metabolic syndrome and T2DM, even a small attributable risk has the potential to lead to large increases in HCC burden worldwide [9].
As T2DM is associated with significant co-morbidities, we hypothesized that the survival would be compromised in this subgroup. Therefore, the aim of this study was to investigate outcomes of patients with HCC and T2DM compared to nondiabetics.
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Patients
All patients diagnosed with HCC at The Royal Melbourne Hospital, Melbourne, Australia, between 1st January 2000 and 31st August 2007 were included in this study. Ethics approval was obtained from Melbourne Health Research Directorate Human Ethics Committee. Data was collected retrospectively between 1st January 2000 and 31st December 2005, and prospectively from 1st January 2006 to 31st August 2007. Diagnosis of HCC was established on positive histopathology of liver biopsy or surgical resection specimen,
Demographic, clinical and tumour features
Demographic, clinical and tumour features of the HCC cohort are shown in Table 1. Cirrhosis was present in 91.1%; all those without cirrhosis had chronic hepatitis B. Alcohol was the most commonest cause of underlying cirrhosis (40.7%) followed by hepatitis C (35%), NASH (23.6%) and hepatitis B (22.8%). The “other” category included two cases of Alagille syndrome and one case of cardiac cirrhosis. Diabetes was present in 43% of our patients (54 had T2DM, four had Type 1 diabetes (T1DM). Only
Discussion
This study examines whether diabetes impacts on the natural history of HCC. Patients with diabetes frequently have significant comorbidities which may complicate treatment of HCC, and diabetes is recognised to be an independent risk factor for HCC. Our hypothesis that diabetic patients would have poorer outcomes was not confirmed by this study. Diabetes did not appear as a statistically significant factor when linked with survival in either treated patients, untreated patients or the overall
Conclusion
Patients with T2DM and HCC had similar outcomes compared to nondiabetics with HCC. There was a nonsignificant trend towards longer survival in diabetics compared to nondiabetics with HCC, despite greater comorbidities in the diabetic cohort.
Conflict of interest statement
The authors have no disclosures or conflict of interest.
Acknowledgements
We would like to thank The Cancer Epidemiology Centre, Victorian Cancer Registry, The Cancer Council Victoria, Melbourne, Australia for providing accurate dates of death for our cohort.
We would also like to thank Kaye Marion for her assistance with some of the survival curves used in this article.
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