T2D dampens survival in HCC patients undergoing transarterial chemoembolization
For patients with intermediate-stage hepatocellular carcinoma (HCC) who have undergone transarterial chemoembolization (TACE), long-term survival decreases in the presence of type 2 diabetes (T2D), a study reports.
The analysis included patients with (n=289) or without (n=763) T2D. Researchers used propensity score matching (PSM) to compare time to progression (TTP) and cancer-specific mortality (CSM) between the two groups.
Compared with non-T2D controls, patients with diabetes showed significantly poorer 5-year TTP and CSM rates in the whole cohort (n=1,052; 81.3 percent vs 70.9 percent; p<0.001 and 61.5 percent vs 49.3 percent; p=0.006, respectively) and in the PSM cohort (n=514; 81.4 percent vs 68.6 percent; p=0.003 and 61.7 percent vs 43.2 percent; p=0.014, respectively).
On multivariate competing risk regression analysis, T2D was independently associated with worse TTP and CSM before PSM (hazard ratio [HR], 1.37, 95 percent confidence interval [CI], 1.07–1.77 and HR, 1.36, 95 percent CI, 1.05–1.75, respectively) and after PSM (HR, 1.29, 95 percent CI, 1.04–1.60 and HR, 1.24, 95 percent CI, 1.02–1.52, respectively).
Furthermore, subgroup analysis revealed that T2D worsened the long-term outcomes of patients with cirrhosis but not those without the liver complication.
Diabetes may reduce the survival of HCC patients by potentially raising the risk of recurrence, since recurrence remains the most significant problem for HCC patients after curative surgery. Also, diabetes can exacerbate existing liver fibrosis, which in turn leads to severe liver failure. It is possible that survival in this population may be prolonged by good control of blood glucose levels and aggressive treatment to preserve liver function. [PLoS One 2014;9:e113858]