The Prognostic Impact of Type II Diabetes Mellitus on Hepatocellular Carcinoma Patients Underwent Loco-regional Therapies

Abstract

Liver cancer is the sixth most common cancer (749,000 new cases), the third cause of cancer-related death (692,000 cases), and accounts for 7% of all cancers. HCC represents more than 90% of primary liver cancers and is a major global health problem. Its incidence is increasing, ranging between 3% and 9% annually depending on the geographical location and variability in the incidence rates correspond closely to the prevalence and pattern of the primary etiologic factors. The development of HCC is mainly due to the high rate of hepatitis B and C infections among Egyptian patients. In Egypt, there is a growing incidence of HCC (10-120/100,000), which represents the leading cause of death from all other cancer sites. HCC has nearly doubled over the last decade from 4.0% in 1993 to 7.2% in 2002 among patients with chronic liver disease (CLD). Diabetes mellitus (DM) is positively associated with risks of several common human malignancies, including cancers of the colon, breast, endometrium, pancreas and liver. Compared with their non-diabetic counterparts, patients with pre-existing DM have a higher risk for developing HCC, and it has been suggested as a potential risk factor for HCC. There is positive association between DM and HCC risk, a possible explanation for this association relates to the fact that diabetes often occurs as part of the metabolic syndrome itself characterized by a group of biochemical abnormalities and associated clinical conditions which include disturbed glucose and insulin metabolism resulting in hyperglycemia and hyperinsulinemia, dyslipidemia, and hypertension. The metabolic derangements associated with metabolic syndrome (hyperinsulinemia, hyperglycemia, and dyslipidemia) can lead to diabetes mellitus and/or atherosclerotic cardiovascular disease. This study was held to evaluate the impact of type 2 DM on the treatment outcome of HCC patients who underwent radiofrequency ablation (RFA) or trans-arterial chemo-embolization (TACE). This study was conducted at Tropical Medicine department and HCC clinic, Ain Shams University Hospitals. The study was approved by the Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements. Data was retrospectively retrieved from the files of patients with hepatocellular carcinoma (HCC) who performed RFA or TACE from January 2007 till December 2012. Patients who fulfilled the inclusion criteria were enrolled in the study.