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. 2024 Jul 26;16(15):2652.
doi: 10.3390/cancers16152652.

Glycemic Burden and Clinical Outcomes of Early Stage Hepatocellular Carcinoma after Curative Treatment

Hyun Joo Lee  1 , Moon Seok Choi  1 , Byeong Geun Song  1 , Won Seok Kang  1 , Geum Youn Gwak  1 , Myung Ji Goh  1 , Yong Han Paik  1 , Joon Hyeok Lee  1 , Dong Hyun Sinn  1
Affiliations

Glycemic Burden and Clinical Outcomes of Early Stage Hepatocellular Carcinoma after Curative Treatment

Hyun Joo Lee et al. Cancers (Basel). .

Abstract

Early-stage hepatocellular carcinoma (HCC) is still difficult to cure for its high recurrence rate. This study aimed to examine whether glycemic burden management could be one way to improve outcomes of early-stage HCC. A total of 137 very early or early-stage HCC patients who underwent resection or ablation at Samsung Medical Center and had glycemic burden assessment were analyzed. Glycemic burden was assessed using hemoglobin A1c (HbA1c) level. Outcomes were recurrence and overall survival. Risks of recurrence and overall survival were compared according to glycemic burden using a cut-off point of 6.5% or two cut-off points of 6.0% and 7.5%. Overall, 51 (37.2%) patients experienced HCC recurrence. The adjusted hazard ratio (aHR) for recurrence comparing patients with HbA1c > 6.5% to those with HbA1c ≤ 6.5% was 2.66 (95% CI: 1.26-5.78). The risk of recurrence increased in a dose-dependent manner by glycemic burden; aHR for 6.0 < HbA1c ≤ 7.5%: 2.00 (95% CI: 0.78-5.55); aHR for HbA1c > 7.5%: 6.05 (95% CI: 2.31-17.5). Mortality was observed in 16 (11.7%) patients. The risk of mortality was higher for HbA1c > 6.5% than for HbA1c ≤ 6.5% (aHR: 2.33; 95% CI: 1.10-5.08). There was also a dose-response relationship between overall survival and glycemic burden. Glycemic burden assessed using HbA1c level was significantly associated with outcomes of early-stage HCC patients. Good glycemic control could be a therapeutic goal to improve clinical outcomes in these populations.

Keywords: HbA1c; IGF-1; diabetes mellitus; glycemic burden; hepatocellular carcinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the study design. HCC = hepatocellular carcinoma; SMC = Samsung Medical Center; BCLC = Barcelona clinic liver cancer; HbA1c = hemoglobin A1c.
Figure 2
Figure 2
Cumulative recurrence rate curves by glycemic control status. (A) Recurrence rate curves were compared between two groups categorized using a cut-off point of 6.5%. (B) Recurrence rate curves were compared among three groups categorized using two cut-off points of 6.0% and 7.5%. (C) Recurrence rate curves were shown comparing four groups subdivided by glycemic burden and body mass index (BMI).
Figure 2
Figure 2
Cumulative recurrence rate curves by glycemic control status. (A) Recurrence rate curves were compared between two groups categorized using a cut-off point of 6.5%. (B) Recurrence rate curves were compared among three groups categorized using two cut-off points of 6.0% and 7.5%. (C) Recurrence rate curves were shown comparing four groups subdivided by glycemic burden and body mass index (BMI).
Figure 3
Figure 3
Overall survival curves and recurrence-free survival curves by glycemic control status. (A) Overall survival curves were compared between two groups categorized using a cut-off point of 6.5%. (B) Overall survival curves were compared among three groups categorized using two cut-off points of 6.0% and 7.5%. (C) Overall survival curves were compared among four groups subdivided by glycemic burden and BMI. (D) Recurrence-free survival curves were shown comparing two groups divided according to a cut-off point of 6.5%. (E) Recurrence-free survival curves were shown comparing three groups subdivided using two cut-off points of 6.0% and 7.5%.
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References

    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer J. Clin. 2021;71:209–249. doi: 10.3322/caac.21660. - DOI - PubMed
    1. Omata M., Cheng A.L., Kokudo N., Kudo M., Lee J.M., Jia J., Tateishi R., Han K.H., Chawla Y.K., Shiina S., et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: A 2017 update. Hepatol. Int. 2017;11:317–370. doi: 10.1007/s12072-017-9799-9. - DOI - PMC - PubMed
    1. Reig M., Forner A., Rimola J., Ferrer-Fàbrega J., Burrel M., Garcia-Criado Á., Kelley R.K., Galle P.R., Mazzaferro V., Salem R., et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J. Hepatol. 2022;76:681–693. doi: 10.1016/j.jhep.2021.11.018. - DOI - PMC - PubMed
    1. Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. Clin. Mol. Hepatol. 2022;28:583–705. doi: 10.3350/cmh.2022.0294. - DOI - PMC - PubMed
    1. Kim J., Kang W., Sinn D.H., Gwak G.Y., Paik Y.H., Choi M.S., Lee J.H., Koh K.C., Paik S.W. Substantial risk of recurrence even after 5 recurrence-free years in early-stage hepatocellular carcinoma patients. Clin. Mol. Hepatol. 2020;26:516–528. doi: 10.3350/cmh.2020.0016. - DOI - PMC - PubMed

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