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Differential Survival Impact of Diabetes Mellitus on Hepatocellular Carcinoma: Role of Staging Determinants

糖尿病对肝细胞癌的差异生存影响: 分期决定因素的作用

  • 影响因子:2.46
  • DOI:10.1007/s10620-020-06053-4
  • 作者列表:"Ho, Shu-Yein","Yuan, Mei-Hsia","Chen, Chu-Chieh","Liu, Po-Hong","Hsu, Chia-Yang","Huang, Yi-Hsiang","Lei, Hao-Jan","Lee, Rheun-Chuan","Huo, Teh-Ia
  • 发表时间:2020-01-18
Abstract

Background Diabetes mellitus (DM) is common in patients with hepatocellular carcinoma (HCC) and may impact survival. Very few studies focused on the influence of DM in different clinical scenarios. We evaluated the prognostic impact of DM on HCC patients stratified by liver dysfunction, Milan criteria, and performance status defined in the Barcelona Clínic Liver Cancer staging parameters. Methods A prospective dataset of 3573 HCC patients between 2002 and 2016 was retrospectively analyzed. The multivariate Cox proportional hazards model was used to identify independent prognostic predictors. The Kaplan–Meier method with a log-rank test was applied to compare the survival distributions between different patient groups. Results Among all, DM was not an independent prognostic predictor in the Cox multivariate analysis ( p  = 0.1044). In the subgroup analysis, DM was not a significant prognostic predictor in Child–Turcotte–Pugh class A or class B/C patients. However, DM was associated with a decreased survival in patients within the Milan criteria (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.155–1.601, p  = 0.0002) and in those with the performance status 0 (HR 1.213, 95% CI 1.055–1.394, p  = 0.0067) in the multivariate Cox analysis, but not in those beyond the Milan criteria and poor performance status. Conclusions DM is highly prevalent in HCC patients and has a distinct survival impact. DM is an independent survival predictor among patients within the Milan criteria and good performance status. These high-risk patients should be closely monitored, and aggressive anticancer treatment should be considered.

摘要

背景糖尿病 (DM) 在肝细胞癌 (HCC) 患者中很常见,可能会影响生存率。很少有研究关注 DM 在不同临床情况下的影响。我们根据巴塞罗那 clic 肝癌分期参数中定义的肝功能障碍、米兰标准和性能状态分层,评价了 DM 对 HCC 患者的预后影响。方法回顾性分析 3573 和 2002年 2016 例 HCC 患者的前瞻性数据集。使用多变量 Cox 比例风险模型确定独立的预后预测因子。采用 Kaplan-Meier 法及 log-rank 检验比较不同患者组之间的生存分布。结果 Cox 多因素分析中,DM 不是独立的预后因素 (p = 0.1044)。在亚组分析中,DM 不是 Child-Turcotte-Pugh a级或 B/C 级患者的显著预后预测因子。然而,在米兰标准范围内,DM 与患者生存率下降相关 (风险比 [HR] 1.36,95% 置信区间 [CI] 1.155-1.601,p = 0.0002) 在多变量 Cox 分析中,表现状态为 0 的患者 (HR 1.213,95% CI 1.055-1.394,p = 0.0067),但不是在那些超出米兰标准和糟糕的表现状态下。结论 DM 在 HCC 患者中非常普遍,并具有明显的生存影响。在米兰标准和良好表现状态的患者中,DM 是独立的生存预测因子。应密切监测这些高危患者,并考虑积极的抗癌治疗。

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翻译标题与摘要 下载文献
影响因子:3.87
发表时间:2020-02-01
DOI:10.1111/liv.14321
作者列表:["Chen VL","Chen Y","Du X","Handelman SK","Speliotes EK"]

METHODS:BACKGROUND AND AIMS:Cirrhosis is characterized by extensive fibrosis of the liver and is a major cause of liver-related mortality. Cirrhosis is partially heritable but genetic contributions to cirrhosis have not been systemically explored. Here, we carry out association analyses with cirrhosis in two large biobanks and determine the effects of cirrhosis associated variants on multiple human disease/traits. METHODS:We carried out a genome-wide association analysis of cirrhosis as a diagnosis in UK BioBank (UKBB; 1088 cases vs. 407 873 controls) and then tested top-associating loci for replication with cirrhosis in a hospital-based cohort from the Michigan Genomics Initiative (MGI; 875 cases of cirrhosis vs. 30 346 controls). For replicating variants or variants previously associated with cirrhosis that also affected cirrhosis in UKBB or MGI, we determined single nucleotide polymorphism effects on all other diagnoses in UKBB (PheWAS), common metabolic traits/diseases and serum/plasma metabolites. RESULTS:Unbiased genome-wide association study identified variants in/near PNPLA3 and HFE, and candidate variant analysis identified variants in/near TM6SF2, MBOAT7, SERPINA1, HSD17B13, STAT4 and IFNL4 that reproducibly affected cirrhosis. Most affected liver enzyme concentrations and/or aspartate transaminase-to-platelet ratio index. PheWAS, metabolic trait and serum/plasma metabolite association analyses revealed effects of these variants on lipid, inflammatory and other processes including new effects on many human diseases and traits. CONCLUSIONS:We identified eight loci that reproducibly associate with population-based cirrhosis and define their diverse effects on human diseases and traits.

翻译标题与摘要 下载文献
影响因子:2.57
发表时间:2020-02-01
DOI:10.1111/eci.13198
作者列表:["Li H","Wieser A","Zhang J","Liss I","Markwardt D","Hornung R","Neumann-Cip AC","Mayerle J","Gerbes A","Steib CJ"]

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