Overall Survival of Hepatocellular Carcinoma Patients with Associated Diabetes Mellitus - A New Possible Prognostic Score

Author(s): Mega A, De Giorgio M, Piccin A, Ferro F, Vittadello F, Marzi L, Pelizzaro F, Spizzo G, Frena A, Di Vasto M, Seeber A.

Background: Diabetes Mellitus (DM) and Hepatocellular carcinoma (HCC) are conditions with common pathophysiological correlations. Currently, HCC treatment is based on the Barcelona Clinic Liver Cancer algorithm (BCLC). However, no studies have shown that the association of DM with HCC can influence prognosis. The American and European guidelines for Liver Disease (AASLD and EASL) suggest that intermediate stage (BCLC-B) HCC cases, should be treated with trans-arterial chemoembolization (TACE). However, several centers are still using other treatments (liver transplantation, liver resection, percutaneous radiofrequency ablation, percutaneous ethanol injection, radioembolization, sorafenib, etc). In 2012, Bolondi and colleagues suggested a further stratification of BCLC-B patients in 4 sub-groups (B1-B4).

Aim of the study: The aim of this study was to retrospectively validate the Bolondi stratification for BCLC-B patients and to establish the impact of DM on overall survival (OS).

Methods: We conducted a retrospective multicenter study in HCC intermediate stage patients. The study period was from 2000 up to 2015. The median follow up was 6.4 years, with a cumulative OS of 37% at 5 years.

Results: 276 patients with HCC B2 stage were identified. The OS at 5 years for type of treatment (“Bolondi Model“ vs TACE), was better when the Bolondi stratification was used (treated with “Bolondi Model“ n= 57 patients, 20.6%; treated with TACE n= 21 patients, 7.6 %; log rang p<0.001; Ranyi type test p<0.001). Multivariate analysis showed that B2 patients had a better OS compared to all other (p <0.05). According to the “Bolondi Model“, patients stratified in B3 and B4 stage would have had a better outcome if treated with liver trans