{"title":"糖尿病和肥胖合并症对肝细胞癌切除术后生存结果的影响：一项多中心回顾性研究","authors":"Hiroji Shinkawa, Masaki Kaibori, Masaki Ueno, Satoshi Yasuda, Hisashi Ikoma, Tsukasa Aihara, Takuya Nakai, Masahiko Kinoshita, Hisashi Kosaka, Shinya Hayami, Yasuko Matsuo, Ryo Morimura, Takayoshi Nakajima, Chihoko Nobori, Takeaki Ishizawa","doi":"10.1159/000540858","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the association of obesity and diabetes mellitus (DM) comorbidity with hepatocellular carcinoma (HCC) recurrence and survival.</p><p><strong>Methods: </strong>We investigated 1,644 patients who underwent hepatic resection for solitary HCC without vascular invasion using computed tomography. Patients were categorized into four groups according to the combination of obesity and DM comorbidities: OB (+) or (-) and DM (+) or (-). Postoperative cumulative recurrence rates within and beyond 2 years and beyond 5 years were assessed.</p><p><strong>Results: </strong>Multivariate Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (HRs) of reduced recurrence-free survival was 1.10 (95% confidence interval [CI]: 0.91-1.33; <i>p</i> = 0.31), 0.94 (95% CI: 0.78-1.12; <i>p</i> = 0.48), and 1.24 (95% CI: 1.01-1.54; <i>p</i> = 0.045) in the OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups compared with the OB(-)DM(-) group, respectively. Additionally, the corresponding adjusted HRs of reduced overall survival were 0.93 (<i>p</i> = 0.57), 0.97 (<i>p</i> = 0.76), and 1.38 (<i>p</i> = 0.013) for OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups, respectively. No significant difference in the early recurrence rate was determined among the four groups. The OB(+)DM(+) group demonstrated an increased risk for late recurrence beyond 2 years and 5 years postoperatively compared with the OB(-)DM(-) group (HR: 1.51; <i>p</i> = 0.024 and HR: 2.53; <i>p</i> = 0.046, respectively). The OB(+)DM(-) and OB(-)DM(+) groups demonstrated an increased risk for late recurrence beyond 5 years postoperatively (HR: 3.83; <i>p</i> < 0.001 and HR: 1.95; <i>p</i> = 0.037, respectively).</p><p><strong>Conclusions: </strong>Obesity and DM coexistence increased late recurrence and worsened prognosis in patients with HCC undergoing hepatic resection. The results help surgeons develop possible different surveillance protocol and need to focus on diabetes/obesity control during life-long surveillance for patients with HCC.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"14 1","pages":"80-91"},"PeriodicalIF":11.6000,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936440/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of Diabetes Mellitus and Obesity Comorbidities on Survival Outcomes after Hepatocellular Carcinoma Resection: A Multicenter Retrospective Study.\",\"authors\":\"Hiroji Shinkawa, Masaki Kaibori, Masaki Ueno, Satoshi Yasuda, Hisashi Ikoma, Tsukasa Aihara, Takuya Nakai, Masahiko Kinoshita, Hisashi Kosaka, Shinya Hayami, Yasuko Matsuo, Ryo Morimura, Takayoshi Nakajima, Chihoko Nobori, Takeaki Ishizawa\",\"doi\":\"10.1159/000540858\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>This study aimed to evaluate the association of obesity and diabetes mellitus (DM) comorbidity with hepatocellular carcinoma (HCC) recurrence and survival.</p><p><strong>Methods: </strong>We investigated 1,644 patients who underwent hepatic resection for solitary HCC without vascular invasion using computed tomography. Patients were categorized into four groups according to the combination of obesity and DM comorbidities: OB (+) or (-) and DM (+) or (-). Postoperative cumulative recurrence rates within and beyond 2 years and beyond 5 years were assessed.</p><p><strong>Results: </strong>Multivariate Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (HRs) of reduced recurrence-free survival was 1.10 (95% confidence interval [CI]: 0.91-1.33; <i>p</i> = 0.31), 0.94 (95% CI: 0.78-1.12; <i>p</i> = 0.48), and 1.24 (95% CI: 1.01-1.54; <i>p</i> = 0.045) in the OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups compared with the OB(-)DM(-) group, respectively. Additionally, the corresponding adjusted HRs of reduced overall survival were 0.93 (<i>p</i> = 0.57), 0.97 (<i>p</i> = 0.76), and 1.38 (<i>p</i> = 0.013) for OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups, respectively. No significant difference in the early recurrence rate was determined among the four groups. The OB(+)DM(+) group demonstrated an increased risk for late recurrence beyond 2 years and 5 years postoperatively compared with the OB(-)DM(-) group (HR: 1.51; <i>p</i> = 0.024 and HR: 2.53; <i>p</i> = 0.046, respectively). The OB(+)DM(-) and OB(-)DM(+) groups demonstrated an increased risk for late recurrence beyond 5 years postoperatively (HR: 3.83; <i>p</i> < 0.001 and HR: 1.95; <i>p</i> = 0.037, respectively).</p><p><strong>Conclusions: </strong>Obesity and DM coexistence increased late recurrence and worsened prognosis in patients with HCC undergoing hepatic resection. The results help surgeons develop possible different surveillance protocol and need to focus on diabetes/obesity control during life-long surveillance for patients with HCC.</p>\",\"PeriodicalId\":18156,\"journal\":{\"name\":\"Liver Cancer\",\"volume\":\"14 1\",\"pages\":\"80-91\"},\"PeriodicalIF\":11.6000,\"publicationDate\":\"2024-08-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936440/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Liver Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000540858\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Liver Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000540858","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Impact of Diabetes Mellitus and Obesity Comorbidities on Survival Outcomes after Hepatocellular Carcinoma Resection: A Multicenter Retrospective Study.
Introduction: This study aimed to evaluate the association of obesity and diabetes mellitus (DM) comorbidity with hepatocellular carcinoma (HCC) recurrence and survival.
Methods: We investigated 1,644 patients who underwent hepatic resection for solitary HCC without vascular invasion using computed tomography. Patients were categorized into four groups according to the combination of obesity and DM comorbidities: OB (+) or (-) and DM (+) or (-). Postoperative cumulative recurrence rates within and beyond 2 years and beyond 5 years were assessed.
Results: Multivariate Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (HRs) of reduced recurrence-free survival was 1.10 (95% confidence interval [CI]: 0.91-1.33; p = 0.31), 0.94 (95% CI: 0.78-1.12; p = 0.48), and 1.24 (95% CI: 1.01-1.54; p = 0.045) in the OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups compared with the OB(-)DM(-) group, respectively. Additionally, the corresponding adjusted HRs of reduced overall survival were 0.93 (p = 0.57), 0.97 (p = 0.76), and 1.38 (p = 0.013) for OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups, respectively. No significant difference in the early recurrence rate was determined among the four groups. The OB(+)DM(+) group demonstrated an increased risk for late recurrence beyond 2 years and 5 years postoperatively compared with the OB(-)DM(-) group (HR: 1.51; p = 0.024 and HR: 2.53; p = 0.046, respectively). The OB(+)DM(-) and OB(-)DM(+) groups demonstrated an increased risk for late recurrence beyond 5 years postoperatively (HR: 3.83; p < 0.001 and HR: 1.95; p = 0.037, respectively).
Conclusions: Obesity and DM coexistence increased late recurrence and worsened prognosis in patients with HCC undergoing hepatic resection. The results help surgeons develop possible different surveillance protocol and need to focus on diabetes/obesity control during life-long surveillance for patients with HCC.
期刊介绍：
Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.
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