The survival outcomes and prognostic factors of hepatocellular carcinoma among type 2 diabetes patients: a two-centre retrospective cohort study

Authors: NOOR ATIKA AZIT, SHAHNORBANUN SAHRAN, VOON MENG LEOW, MANISEKAR K. SUBRAMANIAM, SURYATI MOKHTAR, AZMAWATI MOHAMMED NAWI

Abstract: Background/aim: To determine the survival outcomes and prognostic factors associated with hepatocellular carcinoma (HCC) survival in type 2 diabetes (T2D) patients. Materials and methods: This was a retrospective cohort study involving two hepatobiliary centres from January 1, 2012, to June 30, 2018. Medical records were analysed for sociodemographic, clinical characteristics, laboratory testing, and HCC treatment information. Survival outcomes were examined using the Kaplan?Meier and log-rank test. Prognostic factors were determined using multivariate Cox regression. Results: A total of 212 patients were included in the study. The median survival time was 22 months. The 1-, 3-, and 5-year survival rates were 64.2%, 34.2%, and 18.0%, respectively. Palliative treatment (adjusted hazard ratio [AHR] = 2.82, 95% confidence interval [CI] 1.75?4.52), tumour size ? 5 cm (AHR = 2.02, 95%CI: 1.45?2.82), traditional medication (AHR = 1.94, 95%CI: 1.27?2.98), raised alkaline phosphatase (AHR = 1.74, 95%CI: 1.25?2.42), and metformin (AHR = 1.44, 95%CI: 1.03?2.00) were significantly associated with poor prognosis for HCC survival. Antiviral hepatitis treatment (AHR = 0.54, 95% CI: 0.34?0.87), nonalcoholic fatty liver disease (NAFLD) (AHR = 0.50, 95% CI: 0.30?0.84), and family history of malignancies (AHR = 0.50, 95%CI: 0.26?0.96) were identified as good prognostic factors for HCC survival. Conclusion: Traditional medication, metformin treatment, advanced stage and raised alkaline phosphatase were the poor prognostic factors, while antiviral hepatitis treatment, NAFLD, and family history of malignancies were the good prognostic factors for our HCC cases comorbid with T2D.

Keywords: Hepatocellular carcinoma, type 2 diabetes mellitus, liver neoplasm, prognosis, retrospective studies

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