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. 2021 Aug;10(4):454-463.
doi: 10.21037/hbsn.2020.01.03.

High HbA1c is a risk factor for complications after hepatectomy and influences for hepatocellular carcinoma without HBV and HCV infection

Shingo Shimada  1 , Toshiya Kamiyama  1 , Tatsuya Orimo  1 , Akihisa Nagatsu  1 , Hirofumi Kamachi  1 , Akinobu Taketomi  1
Affiliations

High HbA1c is a risk factor for complications after hepatectomy and influences for hepatocellular carcinoma without HBV and HCV infection

Shingo Shimada et al. Hepatobiliary Surg Nutr. 2021 Aug.

Abstract

Background: Currently, the population with type 2 diabetes mellitus (DM) is increasing worldwide. However, the influence of DM or hyperglycemia on the outcome of resected hepatocellular carcinoma (HCC) is unclear.

Methods: We analyzed 756 patients with HCC who underwent hepatectomy. These patients were assigned to an HbA1c ≥7.0% (H-A1c; n=100) or HbA1c <7.0% (L-A1c; n=656) group depending on their HbA1c level at admission. We investigated prognoses, clinicopathological characteristics and surgical outcomes including morbidities of HCC patients with high HbA1c, prognoses according to the treatment for DM were also investigated.

Results: Among all patients and those with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, overall survival (OS) and relapse-free survival (RFS) did not differ significantly between the H-A1c and L-A1c groups. In contrast, the 5-year OS rate of the H-A1c group was 55% and that of the L-A1c group 71% among patients without HBV and HCV (NBNC patients) (P=0.03). Among NBNC patients, the median RFS of the H-A1c group was 13 months, and that of the L-A1c group was 26 months (P=0.02). In addition, metformin use was an independent favorable factor for both OS and RFS. The H-A1c group had significantly higher rates of hyperbilirubinemia, wound infection, and pneumonia.

Conclusions: HCC patients with high HbA1c might have poor prognoses for both survival and recurrence in NBNC-HCC. High HbA1c may also be a risk factor for morbidities after hepatectomy. Metformin use may constitute a good option for NBNC patients with HCC.

Keywords: HbA1c; Hepatocellular carcinoma (HCC); diabetes mellitus (DM); hepatectomy; metformin.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn.2020.01.03). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overall survival curves for: (A) all patients with HCC; (B) the patients with HCC based on NBNC. HCC, hepatocellular carcinoma; NBNC, NonBNonC.
Figure 2
Figure 2
Relapse-free survival curves for: (A) all patients with HCC; (B) the patients with HCC based on NBNC. HCC, hepatocellular carcinoma; NBNC, NonBNonC.
Figure 3
Figure 3
(A) Overall survival curves and (B) relapse-free survival curves for the patients depending on the treatment for DM. DM, diabetes mellitus.
See this image and copyright information in PMC

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