Prognostic impact of diabetes mellitus on hepatocellular carcinoma: Special emphasis from the BCLC perspective

BACKGROUND:Diabetes mellitus (DM) is associated with higher incidence and poorer prognosis of hepatocellular carcinoma (HCC). The influence of DM on patient survival in different HCC stages is not known. METHODS:A prospective dataset of 3,182 HCC patients was collected between 2002 and 2014. Patients were divided into three groups according to BCLC stages (BCLC stage 0 and stage A, BCLC stage B, BCLC stage C and stage D). We compared the cumulative survival rate of diabetic and non-diabetic patients in different BCLC groups. The correlation between DM and overall survival was also analyzed by multivariate Cox regression model within each group. RESULTS:DM is present in 25.2% of all patients. Diabetic patients had lower cumulative survival in BCLC stage 0 plus BCLC stage A group (log rank p<0.001), and BCLC stage B group (log rank p = 0.012), but not in BCLC stage C plus BCLC stage D group (log rank p = 0.132). Statistically significant differences in overall survival are found between diabetic and non-diabetic patients in BCLC stage 0 plus stage A group (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI] 1.08-1.93, p = 0.013), and BCLC stage B (adjusted HR = 1.77, 95% CI 1.24-2.51, p = 0.002). In contrast, the survival difference is not seen in BCLC stage C plus stage D group (adjusted HR = 1.09, 95% CI 0.90-1.30, p = 0.387). CONCLUSIONS:DM is prevalent in HCC, and is associated with lower survival rate in HCC patients with BCLC stage 0 plus stage A and B, but not in those with BCLC stage C plus stage D