Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: A longitudinal study

OBJECTIVES: Patients with hepatocellular carcinoma (HCC) frequently have diabetes mellitus (DM) due to coexisting liver cirrhosis. The aim of this study was to assess the long-term impact of DM on the hepatic regenerative ability of HCC patients undergoing surgical resection. METHODS: We retrospectively studied 245 HCC patients (210 male; age, 61 +/- 13 yr) with well-preserved liver functions undergoing resection. Forty (16%) of them were diabetic and were controlled with hypoglycemic agents. The Child-Pugh scoring system was used to evaluate the postoperative liver regeneration ability. The endpoint was the occurrence of hepatic decompensation, defined as a sustained increase in the Child-Pugh score of 2 or more points or the development of tumor recurrence. RESULTS: Seventy-five patients (31%) developed hepatic decompensation during a follow-up period of 27 18 months (range, 3-75). DM (p = 0.001), large (>3 cm) tumor size (p = 0.044), and age > 65 yr (p = 0.058) were the factors associated with hepatic decompensation in univariate analysis. Multivariate Cox regression model analysis confirmed that DM (relative risk [RR] = 2.3, 95% Cl = 1.4-3.7, p = 0.001) and tumor size > 3 cm (RR = 1.7, 95% CI = 1.1-2.7, p = 0.046) were independent prognostic predictors associated with the occurrence of hepatic decompensation; the respective 3- and 5-yr cumulative rates were 53% and 64% versus 27% and 50% for diabetic and nondiabetic patients, and 24% and 41% versus 38% and 60% for patients with small (less than or equal to3 cm) versus large (>3 cm) tumors. CONCLUSION: HCC patients with DM or large tumor size are at a cumulative increased risk for postoperative hepatic decompensation.