| Objective: To investigate the effect of type 2 diabetes mellitus(T2DM)on the overall survival rate of patients with hepatocellular carcinoma(HCC).And its correlation such as diabetes duration,insulin treatment,blood glucose fluctuation,and the effect of fasting blood glucose level on the overall survival rate of patients with T2 DM complicated with HCC.Methods: A total of 463 patients with HCC admitted to our hospital from January 2005 to December 2015 were enrolled in this study.The time of follow-up was up to December 2016.It was observed during the follow-up of the prognosis of patients with HCC.Univariate analysis was carried out with Kaplan-Meier survival analysis and Log-rank test,and multivariate analysis was used for Cox proportional hazards regression analysis.P < 0.05 was indicated as statistically significant.The variable which HR>1 was the independent risk factor that affected the overall survival.Results:1.Of the 463 patients with HCC,there were 178 patients with T2 DM complicated with HCC,and the other patients with HCC.There were 378(81.6%)men and 85 women(18.3%),the average age were(53 + 11)years,and the median survival time was 25(95% CI 22.1-27.8)months.2.On 178 cases of diabetic patients with HCC according to the fasting blood glucose level will be divided into three groups(≤7.0mmol/L,7.0-10.0mmol/L and > 10.0mmol/L),each group accounted for 39.3%,22.4%,38.2%.According to the duration of diabetes will be divided into three groups(≤5 years,5-10 years and > 10 years),each accounted for 66.2%,25.2%,10.6%.There were 42 cases of hypoglycemia in the hospital,the proportion was 23.5%.178 patients with diabetes,the use of insulin treatment,there were 88 people,the proportion was 49.4%.Among them,94 patients had a complete 3 days blood glucose spectrum(7 time points of all the time of the day),the survival group was 33 cases,the death group was 61 cases.T test showed that the blood glucose fluctuation of the death group was higher than that in the survival group(P < 0.05).3.The Child-Pugh classification of liver function and various treatment methods were different between the two groups,and the difference was statistically significant(P < 0.05).4.Using an univariate survival analysis,we found that the history of diabetes,AFP,aetiology,liver function Child-Pugh classification,and treatment methods were factors affecting the prognosis of HCC patients(P < 0.05).Compared with the control group,the survival rate of patients with hepatocellular carcinoma(AFP≥200 ng/ml,Child-Pugh grade B+C and other etiologies)was lower(P < 0.05).Multivariate analysis showed that type 2 diabetes mellitus(HR=1.532,P=0.002),Child-Pugh classification B+C(HR=1.389,P < 0.05),TNM stage Ⅲ+Ⅳ(HR=1.301,P < 0.05)were independent risk factors for prognosis of hepatocellular carcinoma.Compared with conservative treatment,operative treatment,TACE and RFA reduced the risk of death with hazard ratios of 1.615(P < 0.05),1.353(P > 0.05),and 1.451(P < 0.05),respectively.5.Univariate analysis showed that gender,smoking history,fasting blood glucose level,hypoglycemia,duration of diabetes,history of insulin use,AFP,Child-Pugh classification,TNM stage and different treatment methods all had significant correlation with the prognosis of patients with T2 DM combined with HCC(P < 0.05).Compared with the control group,the patients of T2 DM with hepatocellular carcinoma have lower survival rate(P < 0.05),with the history of smoking,the history of hypoglycemia,AFP≥ 200 ng/ml,Child-Pugh grade B+C,and TNM stage III + IV.Multivariate analysis showed that smoking history(HR=1.701,P < 0.05),AFP≥200 ng/ml(HR=1.481,P < 0.05),Child-Pugh grading B+C(HR=1.779,P < 0.05),TNM stage III + IV(HR=1.526,P < 0.05)were independent risk factors for the prognosis of combined with prognosis.Compared with conservative treatment,operative treatment,TACE and RFA reduced the risk of death with hazard ratios of 2.267(P < 0.05),1.988(P < 0.05),and 1.479(P > 0.05),respectively.And in patients of T2 DM with HCC,diabetes duration of more than 10 years,compared with in the course of 5 years,the risk of death increased 1.742 times(95% CI 1.321-2.293,P < 0.05).Conclusion: Type 2 diabetes mellitus may be an independent prognostic factor of patients with HCC.Moreover,poor glycemic control,large fluctuations in blood glucose,long duration of diabetes,and the use of insulin may further increase the mortality of patients with HCC.Smoking,AFP≥200 ng/ml,Child-Pugh grade B+C,TNM stage III + IV,treatment method,and diabetes duration > 10 were the independent risk factors for the prognosis of T2 DM with HCC. |
