Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation

• Published in: World journal of gastroenterology : WJG Vol. 22; no. 43; pp. 9571 - 9585
• Main Authors: Zhang, Qing, Deng, Yong-Lin, Liu, Chang, Huang, Li-Hong, Shang, Lei, Chen, Xin-Guo, Wang, Le-Tian, Du, Jin-Zan, Wang, Ying, Wang, Pei-Xiao, Zhang, Hui, Shen, Zhong-Yang
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.11.2016
• Subjects: Antiviral Agents - therapeutic use; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - virology; Chi-Square Distribution; China - epidemiology; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Disease-Free Survival; Female; Hepatitis B - diagnosis; Hepatitis B - epidemiology; Hepatitis B - mortality; Humans; Kaplan-Meier Estimate; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Neoplasms - virology; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Proportional Hazards Models; Registries; Retrospective Studies; Retrospective Study; Risk Factors; Survivors; Time Factors; Treatment Outcome; Hepatocellular carcinoma; Hepatitis B virus; Survival; Diabetes mellitus; Liver transplantation
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v22.i43.9571

AIM to determine whether diabetes mellitus(DM) affects prognosis/recurrence after liver transplantation(Lt) for hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC). METHODS 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. RESULTS 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 preLt 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/m L(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. CONCLUSION 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.