In the Journals

Outcomes after HCV-related HCC resection unaffected by diabetes

Diabetes did not affect the surgical outcomes of patients with hepatitis C-related hepatocellular carcinoma following liver resection, according to results of a recently published study.

“It has been commonly understood that [diabetes] is a risk factor for the development of HCC, especially in patients with HCV infection. However, it is still controversial whether [diabetes] affects the prognosis and operative outcomes of patients with HCC,” the researchers wrote. “In the present study, [diabetes] did not appear to have a negative impact on patients’ survival after HCC resection, suggesting that [diabetes] is not an exclusion criterion for HCC surgery under good glycemic control.”

Researchers compared clinical characteristics and surgical outcomes between 112 patients with HCV-related HCC with diabetes and 112 propensity-matched patients without diabetes who underwent curative liver resection between January 2001 and December 2013.

Preoperatively, the physicians aimed to keep the urinary glucose levels of the patients with diabetes at less than 3 g per day and plasma glucose levels within 110 mg/dL to 180 mg/dL. Following surgery, the aim was to keep serum glucose levels under 200 mg/dL and monitor the blood and urinary sugar levels.

Forty-eight of the patients with diabetes and 54 of the non-diabetic patients had postoperative complications with no significant difference in the Clavien-Dindo Classification of Surgical Complications between the two groups.

Sixty-nine of the patients with diabetes and 74 of the patients without diabetes had HCV recurrence after a median follow-up of 3.2 years (range, 0.2-11.3 years). There were no significant differences in recurrence site or treatments for recurrent HCC between the two groups.

Regarding the patients with diabetes, the median overall survival rate was 5.2 years (95% CI, 3.8-6.5) and the recurrence-free survival rate was 2.2 years (95% CI, 1.7-3.6). For the patients without diabetes, the median OS rate was 6.3 years (95% CI, 5.4-7.1) and 2.2 years (95% CI, 1.7-3.6) for recurrence-free survival. Background liver (HR 2.06; 95% CI, 1.27-3.39) and tumor differentiation grade (HR 2.07; 95% CI, 1.14-4.05) were independent factors for OS.

In a subgroup analysis of survival, the median OS rate for patients with diabetes and cirrhosis was 3.8 years (95% CI, 2.9-92) and 1.9 years (95% CI, 1.5-2.8) for recurrence-free survival. The median OS rate for non-diabetic patients with cirrhosis was 6.3 years (95% CI, 3.5-11.8) and was 2.2 years (95% CI, 0.9-4.3) for recurrence-free survival.

“Consistent with our data obtained in HCV patients, [diabetes] did not significantly affect the surgical outcomes after curative liver resection in patients with hepatitis B virus-related HCC. However, overall survival was significantly shorter in patients with cirrhosis as determined by subclass analysis, possibly because hyperglycemia and insulin resistance accelerate the progression of liver fibrosis, leading to liver failure,” the researchers wrote. “We investigated whether liver cirrhosis and tumor differentiation grade, which were independent factors for overall survival in the present study, could affect the prognosis of patients with HCV-related HCC. In contrast to previous reports regarding hepatitis B virus-related HCC, survival rates of patients with cirrhosis were not significantly different between the [diabetes] and non-[diabetes] groups. This could be attributable to the good control of HbA1c level after liver resection in this series, and the different type of hepatitis virus infection.” – by Talitha Bennett