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目的:研究糖尿病(DM)对原发性肝细胞癌(HCC)患者R0切除术后预后的影响。方法:回顾性分析2001-01-01-2009-12-31青岛大学医学院附属医院肝胆外科518例获R0切除术的原发性HCC患者临床资料,单因素分析伴有DM和无DM的HCC患者临床病理因素的差异,及DM患者术前治疗方式对生存的影响;Kaplan-Meier分析患者预后。结果:HCC伴有DM者79例(15.3%,DM组),无DM的者439例(84.7%,无DM组)。单因素分析显示,DM组中男性(χ2=5.099,P=0.013)以及年龄>60岁(χ2=7.050,P=0.007)者较无DM组多;两组术后的中位无瘤生存(DFS)时间均为26个月,χ2=0.000,P=0.987;中位生存(OS)时间分别为56和50个月,χ2=0.002,P=0.964。DM组的感染性和切口并发症发生率为55.6%和44.4%,显著高于无DM组的16.2%和13.2%,χ2=7.487,P=0.016;χ2=5.517,P=0.039。在DM组中,诊断为隐性DM者(27例,34.2%),其肿瘤直径>5cm(χ2=4.403,P=0.032)、血管侵犯(χ2=13.515,P=0.001)、非孤立型HCC(χ2=8.413,P=0.005)、TNM分期为Ⅲ～Ⅳ期(χ2=8.413,P=0.005)和术后短期复发(χ2=8.583,P=0.006)者显著多于有DM病史者(52例,65.8%)。79例DM患者中,术前DM胰岛素治疗组患者(12例)R0切除术后中位DFS(48.8个月)显著高于其他治疗组(25例,28个月)或无治疗组(42例,19.5个月),χ2=6.654,P=0.002;中位OS(49.9个月)亦高于另外两组(41.4和37.5个月),χ2=3.277,P=0.043。结论:有无伴存DM的HCC患者获R0切除术后预后无差异,但伴存DM者术后感染性和切口并发症的发生率高。隐性DM患者肿瘤恶性程度高且R0切除术后短期复发率高。胰岛素治疗组患者的R0切除术后无瘤生存和总体生存时间长。
Objective: To investigate the effect of diabetes mellitus (DM) on the prognosis of patients with primary hepatocellular carcinoma (HCC) after R0 resection. Methods: A retrospective analysis of the clinical data of 518 patients with primary HCC who underwent R0 resection at the Affiliated Hospital of Medical College of Qingdao University from January 2001 to December 2009 was performed. Univariate analysis was performed with HCC without DM The difference of clinicopathological factors, and the influence of preoperative treatment on DM patients survival; Kaplan-Meier analysis of patient prognosis. Results: There were 79 patients (15.3%, DM group) with HCC accompanied by DM and 439 (84.7%, without DM) without DM. Univariate analysis showed that there was more DM in the DM group than in the DM group (χ2 = 5.099, P = 0.013) and age> 60 years (χ2 = 7.050, P = 0.007) DFS) were 26 months, χ2 = 0.000, P = 0.987; median OS was 56 and 50 months, respectively, χ2 = 0.002, P = 0.964. The incidence of infective and incisional complications in DM group was 55.6% and 44.4%, significantly higher than 16.2% and 13.2% in no DM group, χ2 = 7.487, P = 0.016; χ2 = 5.517, P = 0.039. In DM group, the diagnosis was occult DM (27 cases, 34.2%). The diameter of tumor was> 5 cm (χ2 = 4.403, P = 0.032) (χ2 = 8.413, P = 0.005). TNM stage Ⅲ ~ Ⅳ (χ2 = 8.413, P = 0.005) and postoperative short-term recurrence (χ2 = 8.583, Case, 65.8%). Among 79 patients with DM, the median DFS (48.8 months) after R0 resection was significantly higher in preoperative DM insulin treatment group (n = 12) than in other treatment groups (n = 25) or no treatment group (n = 42) , 19.5 months), χ2 = 6.654, P = 0.002; median OS (49.9 months) also higher than the other two groups (41.4 and 37.5 months), χ2 = 3.277, P = 0.043. Conclusion: There is no difference in the prognosis of patients with or without HCC after R0 resection. However, the incidence of postoperative infection and incision complications is high in HCC patients with or without DM. Patients with occult DM have a high degree of malignancy and a high rate of short-term recurrence after R0 resection. Patients in the insulin-treated group had longer tumor-free and overall survival after R0 resection.