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The Role of Pre-Existing Diabetes Mellitus on Hepatocellular Carcinoma Occurrence and Prognosis: A Meta-Analysis of Prospective Cohort Studies

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  • Wan-Shui Yang
  • Puthiery Va
  • Freddie Bray
  • Shan Gao
  • Jing Gao
  • Hong-Lan Li
  • Yong-Bing Xiang

Abstract

Background: The impact of pre-existing diabetes mellitus (DM) on hepatocellular carcinoma (HCC) occurrence and prognosis is complex and unclear. The aim of this meta-analysis is to evaluate the association between pre-existing diabetes mellitus and hepatocellular carcinoma occurrence and prognosis. Methods: We searched PubMed, Embase and the Cochrane Library from their inception to January, 2011 for prospective epidemiological studies assessing the effect of pre-existing diabetes mellitus on hepatocellular carcinoma occurrence, mortality outcomes, cancer recurrence, and treatment-related complications. Study-specific risk estimates were combined by using fixed effect or random effect models. Results: The database search generated a total of 28 prospective studies that met the inclusion criteria. Among these studies, 14 reported the risk of HCC incidence and 6 studies reported risk of HCC specific mortality. Six studies provided a total of 8 results for all-cause mortality in HCC patients. Four studies documented HCC recurrence risks and 2 studies reported risks for hepatic decomposition occurrence in HCC patients. Meta-analysis indicated that pre-existing diabetes mellitus (DM) was significantly associated with increased risk of HCC incidence [meta-relative risk (RR) = 1.87, 95% confidence interval (CI): 1.15–2.27] and HCC-specific mortality (meta-RR = 1.88, 95%CI: 1.39–2.55) compared with their non-DM counterparts. HCC patients with pre-existing DM had a 38% increased (95% CI: 1.13–1.48) risk of death from all-causes and 91% increased (95%CI: 1.41–2.57) risk of hepatic decomposition occurrence compared to those without DM. In DM patients, the meta-RR for HCC recurrence-free survival was 1.93(95%CI: 1.12–3.33) compared with non-diabetic patients. Conclusion: The findings from the current meta-analysis suggest that DM may be both associated with elevated risks of both HCC incidence and mortality. Furthermore, HCC patients with pre-existing diabetes have a poorer prognosis relative to their non-diabetic counterparts.

Suggested Citation

  • Wan-Shui Yang & Puthiery Va & Freddie Bray & Shan Gao & Jing Gao & Hong-Lan Li & Yong-Bing Xiang, 2011. "The Role of Pre-Existing Diabetes Mellitus on Hepatocellular Carcinoma Occurrence and Prognosis: A Meta-Analysis of Prospective Cohort Studies," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-11, December.
    • Handle: RePEc:plo:pone00:0027326
    DOI: 10.1371/journal.pone.0027326
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    1. Sue Duval & Richard Tweedie, 2000. "Trim and Fill: A Simple Funnel-Plot–Based Method of Testing and Adjusting for Publication Bias in Meta-Analysis," Biometrics, The International Biometric Society, vol. 56(2), pages 455-463, June.
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    1. Yohwan Yeo & Seung-Hyun Ma & Yunji Hwang & Pamela L Horn-Ross & Ann Hsing & Kyu-Eun Lee & Young Joo Park & Do-Joon Park & Keun-Young Yoo & Sue K Park, 2014. "Diabetes Mellitus and Risk of Thyroid Cancer: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-11, June.
    2. Xin Xu & Jian Wu & Yeqing Mao & Yi Zhu & Zhenghui Hu & Xianglai Xu & Yiwei Lin & Hong Chen & Xiangyi Zheng & Jie Qin & Liping Xie, 2013. "Diabetes Mellitus and Risk of Bladder Cancer: A Meta-Analysis of Cohort Studies," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.

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