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HCV liver cancer resection outcomes similar in patients with diabetes

Results of a comparative study of patients with and without diabetes who underwent curative liver resection for hepatitis C-related hepatocellular carcinoma showed that diabetes did not affect surgical outcomes and was not an unfavorable factor in selecting candidates.

“It is still controversial whether [diabetes] influences the survival of patients with HCC after resection. Such discrepancies in the results in each investigation could be attributed to the diversity of patient backgrounds, as well as the number of patients,” Naoki Yoshida, MD, from the Nihon University School of Medicine, Japan, and colleagues 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.”

Between January 2001 and December 2013, 402 patients with HCC who were positive for anti-HCV antibody and negative for hepatitis B surface antigen underwent curative liver resection at Nihon University Itabashi Hospital. Investigators then compared the 112 patients diagnosed with noninsulin-dependent diabetes against 112 propensity-matched patients without diabetes.

Forty-eight patients with diabetes and 54 without had postoperative complications and 32 patients from each group had morbidities after liver resection.

After a median-follow-up of 3.2 years (range, 0.2-11.3 years), 69 patients with diabetes and 74 without had recurrence of HCC. Forty patients with diabetes and 31 without died of liver cancer recurrence. One patient with diabetes and two patients without died of liver failure.

Median overall and recurrence-free survival was 5.2 years (range, 3.8-6.5 years) among patients with diabetes and 2.2 years (range, 1.7-2.9 years) in those without. Five-year rates of overall survival were 51.7% (95% CI, 41.4-64.6) in patients with diabetes and 60.6% (95% CI, 50.3-73.1) in those without and 5-year recurrence-free survival rates were 24.5% (95% CI, 15.8-37.9) in patients with diabetes and 28.6% (95% CI, 19.3-42.3) in those without.

The researchers observed no significant differences in any of the above comparisons between the two groups.

Similarly, in a subset analysis, the researchers observed no significant difference between the two groups among patients with cirrhosis, those with moderately differentiated HCC and those with well-differentiated HCC.

The independent factors for overall survival included background liver (HR = 2.06; 95% CI, 1.27-3.39) and tumor differentiation grade (HR = 2.07; 95% CI, 1.14-4.05).

“It has been reported that [diabetes] did not increase morbidity after HCC resection, and it did not significantly impact the overall and disease-free survival of 62 diabetic and 463 non-diabetic patients. Therefore, [diabetes] should not be considered an unfavorable factor in the selection of patients for HCC resection,” the researchers concluded. “However, [diabetes] was shown to be a risk factor for recurrence of HCV-related HCC after curative resection, although there were only a small number of HCV patients (22 diabetic and 40 non-diabetic patients).” – by Talitha Bennett

Disclosure: The authors report relevant financial disclosures.