Impact of diabetes mellitus on the prognosis of patients with hepatocellular carcinoma

BACKGROUND. The majority of patients with hepatocellular carcinoma (HCC) ha ve coexisting cirrhosis or chronic hepatitis, often complicated by diabetes mellitus. In the current study, the authors evaluated the impact of diabet es mellitus on the prognosis of patients with HCC. METHODS. Among 581 patients with HCC who had been diagnosed and treated bet ween 1990 and 1999, survival was compared between those patients with and t hose patients without diabetes mellitus. The rate of disease recurrence aft er treatment also was analyzed. RESULTS. Ninty-two patients (15.8%) had diabetes mellitus. There was no sig nificant difference with regard to patient characteristics (i.e., age, gend er, or alcohol intake) or liver function between those patients with and th ose patients without diabetes mellitus. No differences were observed in sur vival between patients with diabetes mellitus and patients without it. Amon g the 195 patients with a solitary HCC lesion measuring less than or equal to 3 cm in greatest dimension, the survival of the 32 patients with diabete s mellitus was significantly poorer than that of the 163 patients without d iabetes mellitus (P = 0.0273), despite no apparent difference in liver func tion between the 2 groups. On multivariate analysis, diabetes mellitus was found to be an independent factor predicting lower survival after treatment (P = 0.0077) among patients with a solitary HCC lesion measuring less than or equal to 3 cm in greatest dimension. No difference in the rate of recur rence was observed between the two groups in all the patients and in those patients with a solitary HCC lesion measuring less than or equal to 3 cm in greatest dimension. CONCLUSION, The results of the current study indicated that the presence of diabetes mellitus worsens the prognosis of patients with a solitary HCC le sion measuring less than or equal to 3 cm in greatest dimension; it appears to impact prognosis in patients with HCC when HCC is treatable, based on t he size and the number of lesions. However, diabetes mellitus did not appea r to affect the prognosis in the general population of patients with HCC. B ased on the current study data, diabetes mellitus does not appear to modify the progression of HCC and its recurrence after treatment, but it does app ear to worsen the prognosis of patients with HCC by means of a rapid declin e in remnant liver function caused by repeated treatment of ACC.(C) 2001 Am erican Cancer Society.