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中华介入放射学电子杂志 ›› 2015, Vol. 03 ›› Issue (01) : 13 -17. doi: 10.3877/cma.j.issn.2095-5782.2015.01.004

所属专题: 文献

肿瘤介入

肝动脉化疗栓塞治疗原发性肝癌合并糖尿病的预后因素分析
常中飞1, 段峰2, 孙红梅3, 王茂强2,()   
  1. 1. 100853 北京,解放军总医院介入放射科;100043 北京,首都医科大学石景山教学医院北京市石景山医院肿瘤科
    2. 100853 北京,解放军总医院介入放射科
    3. 100043 北京,首都医科大学石景山教学医院北京市石景山医院肿瘤科
  • 收稿日期:2014-07-12 出版日期:2015-02-01
  • 通信作者: 王茂强

Prognostic factors of hepatocellular carcinoma with diabetes mellitus treated with transarterial chemoembolization

Zhongfei Chang1, Feng Duan2, Hongmei Sun3, Maoqiang Wang2,()   

  1. 1. Department of Interventional Radiology, PLA General Hospital, Beijing, 100853, China
  • Received:2014-07-12 Published:2015-02-01
  • Corresponding author: Maoqiang Wang
  • About author:
    Corresponding author: Wang Maoqiang, Email:
引用本文:

常中飞, 段峰, 孙红梅, 王茂强. 肝动脉化疗栓塞治疗原发性肝癌合并糖尿病的预后因素分析[J/OL]. 中华介入放射学电子杂志, 2015, 03(01): 13-17.

Zhongfei Chang, Feng Duan, Hongmei Sun, Maoqiang Wang. Prognostic factors of hepatocellular carcinoma with diabetes mellitus treated with transarterial chemoembolization[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2015, 03(01): 13-17.

目的

分析145例肝癌合并2型糖尿病患者的临床资料,探讨肝动脉灌注化疗栓塞(TACE)的疗效及相关预后因素。

方法

回顾性分析145例肝癌合并2型糖尿病患者经TACE治疗的疗效及预后因素分析。生存率用Kaplan-Meier法计算,单因素分析采用Log-Rank方法,多因素分析采用Cox回归模型。

结果

DM组与非DM组患者的总生存时间无统计学差异(P>0.05)。DM组患者较非DM组患者发生肝外转移率高,两组比较具有统计学意义(P<0.005)。分层分析显示:DM组中,空腹血糖≥8 mmol/L与空腹血糖<8 mmol/L相比,中位生存时间分别为15个月和30个月,具有统计学意义(P<0.001)。Cox多元回归分析显示:空腹血糖水平、肿瘤大小、ECOG评分、BCLC分期及门脉癌栓是影响HCC合并糖尿病患者预后的独立危险因素。

结论

空腹血糖水平可以作为影响HCC合并糖尿病患者疗效的独立预后因素。

Objective

To evaluate the effect and prognostic factors of 145 cases of HCC patients with diabetes mellitus (DM) treated with TACE.

Methods

A retrospective analysis about the effect and prognostic factors of TACE was conducted on 145 cases of HCC patients with DM. The survival rates were calculated using the Kaplan-Meier method. The log-rank method was used for univariate analysis, and the Cox regression model was used for multivariate analysis.

Results

There was no marked difference the 2 groups patients in postoperative overall survival (P>0.05). There was significant difference between the patients HCC with DM and those without DM in distant metastasis (P<0.05). The hierarchical analysis results show: DM group comparison between groups, Compared with fasting plasma glucose≥8 mmol/L HCC patients, patients with fasting plasma glucose < 8 mmol/L status, Statistically significant (P<0.001) , The median survival time 15.0 (95% CI 13.648-16.352) and 30.0 (95% CI 24.979-35.021) , respectively. Multivariate analysis indicated fasting blood glucose level, tumor size > 8 cm, ECOG score, BCLC grade and PVTT were independent prognostic factors.

Conclusions

Inadequate maintenance of blood glucose in diabetic patients is a significant risk factor for metastasis of HCC and for poor survival after curative TACE therapy.

表1 两组原发性肝癌患者的临床基线特征比较
图1 不同血糖水平对HCC合并糖尿病患者生存率的影响
表2 HCC合并糖尿病患者的组间临床基线特征
表3 HCC合并糖尿病患者预后因素Cox模型多因素分析
1
El-Serag HB. Hepatocellular carcinoma[J]. N Engl J Med, 2011,365(12):1118-1127.
2
王轶,于成功.糖尿病与原发性肝癌[J].中华糖尿病杂志,2009,1(4):304-306.
3
Lai SW, Chen PC, Liao KF, et al. Risk of hepatocellular carcinoma in diabetic patients and risk reduction associated with anti-diabetic therapy: a population-based cohort study[J]. Am J Gastroenterol,2012,107(1):46-52.
4
Kawamura Y, Ikeda K, Arase Y, et a1.Diabetes mellitus worsens the recurrence rate after potentially curative therapy in patients with hepatocellular carcinoma associated with nonviral hepatitis[J].J Gastroenterol Hepatol,2008,23:1739-1746.
5
Amarapurkar DN, Patel ND, Kamani PM.Impact of diabetes mellitus on outcome of HCC[J].Ann Hepatol, 2008,7:148-151.
6
Connolly GC, Safadjou S, Chen R, et al. Diabetes mellitus is associated with the presence of metastatic spread at disease presentation in hepatocellular carcinoma[J]. Cancer Invest, 2012,30(10):698-702.
7
夏景林.原发性肝癌的规范化诊疗[J].中国临床医生,2012,40(1):26-30.
8
Serag H, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma[J]. Gastroenterology, 2004,126(2):460-468.
9
Pavila JA, Morgan R0, Shaib Y, et a1. Diabetes increases the risk of hepatocellular carcinoma in the United states: a population based case control study[J].Gut, 2005,54:533-539.
10
Wang C, Wang X, Gong G, et al. Increased risk of hepatocellular carcinoma in patients with diabetes mellitus:A systematic review and meta-analysis of cohort studies[J].Int J Cancer,2012,130(7):1639-1648.
11
Valter D, Massimiliano B, Francesca V, et al. Glycated hemoglobin and antidiabetic strategies as risk factors for hepatocellular carcinoma[J]. World J Gastroenterol, 2010,16(24):3025-3032.
12
欧迪鹏,杨连粤,曾志军,等.糖尿病对肝癌肝切除术预后的影响[J].中华肝胆外科杂志,2007,13(5):317-319.
13
Takanori H, Masayuki K, Kaoru T, et al. Hyperglycemia is a significant prognostic factor of hepatocellular carcinoma after curative therapy[J]. World J Gastroenterol, 2013,19(2):249-257.
14
Liu H, Ma Q, Li J. High glucose promotes cell proliferation and enhances GDNF and RET expression in pancreatic cancer cells[J]. Mol Cell Biochem, 2011,347:95-101.
15
Nishikawa T, Edelstein D, Du XL, et al. Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage[J]. Nature, 2000,404:787-790.
16
Kawaguchi T, Taniguchi E, Morita Y, et al. Association of exogenous insulin or sulphonylurea treatment with an increased incidence of hepatoma in patients with hepatitis C virus infection[J]. Liver Int, 2010,30:479-486.
17
Giovannucci E, Michaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas[J]. Gastroenterology, 2007,132:2208-2225.
18
Currie CJ, Poole CD, Gale EA. The influence of glucoselowering therapies on cancer risk in type 2 diabetes[J]. Diabetologia, 2009,52:1766-1777.
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