Evaluation of metabolic factors on the prognosis of patients undergoing resection of hepatocellular carcinoma

Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
Journal of Gastroenterology and Hepatology (Impact Factor: 3.5). 03/2011; 26(3):536-43. DOI: 10.1111/j.1440-1746.2010.06439.x
Source: PubMed


The metabolic factors including obesity, diabetes, and hypertension have been implicated as risk factors of hepatocellular carcinoma (HCC) in patients with chronic hepatitis. The effects of metabolic factors were investigated on the prognosis of patients undergoing resection of HCC.
A total of 469 HCC patients were classified into three groups; hepatitis B virus (HBV)-, hepatitis C virus (HCV)-, and non-HBV/HCV (NBC)-related HCC. Further, the patients with HCV-related HCC were sub-classified into three groups; the patients who did not have documented hypertension, hypertensive patients who received angiotensin II-blocking agents (ABA), and hypertensive patients who received no ABA.
There were no significant difference of survival in the HBV-HCC and NBC-HCC patients with or without obesity, diabetes, and hypertension. In the patients with HCV-related HCC, however, hypertensive patients were significantly worse on both disease-free and overall survivals than non-hypertensive patients. Among the HCV-HCC patients with chronic hepatitis, hypertensive patients with ABA had significantly better preoperative liver function, and hypertensive patients without ABA were significantly worse on both disease-free and overall survivals than those of hypertensive patients with ABA and non-hypertensive patients.
Results suggest that hypertension is a risk factor for a poor prognosis after resection of HCV-related HCC. Angiotensin II blockade may improve the prognosis of hypertensive patients with early hepatic fibrosis after resection in HCV-related HCC.

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    • "Lastly, hypertension has been investigated as a possible independent predictor of HCC survival [17], although more conclusive data are required. "
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    ABSTRACT: Aim of this study was to investigate the role of aetiology, diabetes, tobacco smoking and hypertension in the survival of patients with hepatocellular carcinoma. A prospective cohort of 552 patients (81.5% males, mean age 64.4 years) first diagnosed with hepatocellular carcinoma in 1995-2001 in Brescia, Italy, was retrospectively analyzed. Data on the presence of diabetes mellitus, hypertension, heavy alcohol intake and tobacco smoking were obtained from patients' clinical charts or interviews. Survival analysis was performed using univariate and multivariate methods (Cox proportional hazards model). 33% had a history of heavy alcohol intake, 24.3% had viral hepatitis and 33.5% had both aetiologies. Diabetes, hypertension and tobacco smoking were found in 29.9%, 37.9% and 35.9%, respectively. During follow-up (median 19.9 months), the median survival was 19.9 (95% confidence interval [CI] 16.7-22.8) months. Using multivariate Cox regression models, alcohol-related liver disease and diabetes were found to be associated with mortality, with hazard ratios of 1.32 (95% CI 0.99-1.75) and 1.25 (95% CI 1.02-1.54), respectively. Hypertension and smoking habit did not influence survival. Alcohol aetiology and the presence of diabetes were positively associated with patient mortality with hepatocellular carcinoma, whereas tobacco smoking and hypertension were not. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Jul 2015 · Digestive and Liver Disease
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    • "Of the 3,973 abstracts identified, we excluded 3,943 abstracts and further reviewed 30 full-text articles to determine whether they met our inclusion and exclusion criteria [23]–[52]. 8 studies were excluded for no data available [43], [45]–[48], [50]–[52], and 2 studies were excluded for irrelevant studies [44], [49]. One article included two different patient cohorts, and was extracted as two separate studies [42]. "
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    ABSTRACT: Previous studies suggested that diabetes mellitus was associated with cancer risk and prognosis, but studies investigating the relationship between diabetes mellitus and survival in patients with hepatocellular carcinoma (HCC) reported inconsistent findings. To derive a more precise estimate of the prognostic role of diabetes mellitus in HCC, we systematically reviewed published studies and carried out a meta-analysis. Eligible articles were identified in electronic databases from their inception through September 16, 2013. To evaluate the correlation between diabetes mellitus and prognosis in HCC, the pooled hazard ratios (HR) and their 95% confidence intervals (95% CI) for poorer overall and disease-free survivals were calculated by standard meta-analysis techniques with fixed-effects or random-effects models. 21 studies with a total of 9,767 HCC patients stratifying overall survival and/or disease-free survival in HCC patients by diabetes mellitus status were eligible for meta-analysis. 20 studies with a total of 9,727 HCC cases investigated the overall survival, and 10 studies with a total of 2,412 HCC patients investigated the disease-free survival. The pooled HRs for overall survival and disease-free survival were 1.46 (95% CI, 1.29 to 1.66; P<0.001) and 1.57 (95% CI, 1.21 to 2.05; P = 0.001), respectively. The adjusted HRs for overall survival and disease-free survival were 1.55 (95% CI, 1.27 to 1.91; P<0.001) and 2.15 (95% CI, 1.75 to 2.63; P<0.001), respectively. In addition, for patients receiving hepatic resection, diabetes mellitus was associated with both poorer overall survival and poorer disease-free survival, and for patients receiving non-surgical treatment or patients receiving radiofrequency ablation, diabetes mellitus was associated with poorer overall survival. There was no evidence for publication bias. Diabetes mellitus is independently associated with both poorer overall survival and poorer disease-free survival in HCC patients.
    Full-text · Article · May 2014 · PLoS ONE
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