Diabetes mellitus and hepatocellular carcinoma: Comparison of Chinese patients with and without HBV-related cirrhosis

Table 1 Demographic, clinical, laboratory, metabolic and instrumental features of 224 hepatocellular carcinoma patients n (%)

Variable	HCC patients (n = 224)1
Mean age (yr)	54.6 ± 10.7
Male sex	190 (84.8)
Liver cirrhosis	122 (54.5)
Diabetes mellitus	27 (12.1)
Overweight or obesitya	95 (58.6)
Hypertension	59 (26.3)
Body weight (kg)	68.8 ± 11.0
Body heighta (cm)	169.4 ± 6.4
Mean body mass indexa (kg/m2)	23.9 ± 3.4
Systolic blood pressure (mmHg)	128 ± 16
Diastolic blood pressure (mmHg)	79 ± 9
Mean artery pressure (mmHg)	95 ± 10
Past history of HBV infection	173 (77.2)
Smoking	99 (44.2)
Alcohol intake	69 (30.8)
Positive for HBeAgb	52 (26.1)
HBV-DNAc, Log10	5.32 ± 1.40
AFPd, > 400 ng/mL	110 (50.9)
Child-Pugh Score2	6 (5-8)
Blood Glucose (mmol/L)	5.88 ± 2.22
Total Bilirubin2 (mg/L)	13 (8-23)
Albumin level (g/L)	36.6 ± 6.3
International normalized ratio	1.22 ± 0.24
Alanine aminotransferase2 (U/L)	53 (34-83)
γ-glutamyl transferase2 (U/L)	113 (58-254)
Platelet count2 (× 109/L)	125 (81-183)
Triglyceridese (mmol/L)	1.02 ± 0.52
Total cholesterole (mmol/L)	4.27 ± 1.33
HDL cholesterolf (mmol/L)	0.93 ± 0.44
LDL cholesterolf (mmol/L)	2.44 ± 1.06
Creatinine2 (mg/dL)	0.9 (0.8-1.0)
Blood urea nitrogen2 (mmol/L)	4.98 (3.92-6.28)

¹Plus-minus value indicates mean ± SD;

²Median (inter-quartile range, Q1-Q3). Data were available in

^a162,

^b199,

^c57,

^d216,

^e148 and

^f132 patients. AFP: α-fetoprotein; HBV: Hepatitis B virus; HDL: High-density lipoprotein; LDL: Low-density lipoprotein.

Table 2 Comparison of clinical classification, clinical stage and tumor nodus metastasis stage of hepatocellular carcinoma patients with cirrhosis (n = 122) and patients without cirrhosis (n = 102) n (%)

	Total patients (n = 224)	Patients with LC (n = 122)	Patients without LC (n = 102)	P value1
Clinical classification
Massive-type	134 (59.8)	52 (42.6)	82 (80.4)	< 0.001
Nodular-type	61 (27.2)	49 (40.2)	12 (11.8)	< 0.001
Small-type	15 (6.7)	13 (10.7)	2 (2.0)	0.010
Diffuse-type	14 (6.3)	8 (6.6)	6 (5.9)	0.835
Clinical Stage
Stage I	15 (6.7)	9 (7.4)	6 (5.9)	0.656
Stage II	95 (42.4)	44 (36.1)	51 (50.0)	0.036
Stage III	114 (50.9)	69 (56.6)	45 (44.1)	0.064
TNM stage
Stage I	11 (4.9)	8 (6.6)	3 (2.9)	0.212
Stage II	43 (19.2)	34 (27.9)	9 (8.8)	< 0.001
Stage III	76 (33.9)	30 (24.6)	46 (45.1)	0.001
Stage IV	94 (42.0)	50 (41.0)	44 (43.1)	0.745
T Stage
Stage 1-2	81 (36.2)	61 (50.0)	20 (19.6)	< 0.001
Stage 3-4	143 (63.8)	61 (50.0)	82 (80.4)	-
N Stage
Stage 0	194 (86.6)	110 (90.2)	84 (82.4)	0.087
Stage 1	30 (13.4)	12 (9.8)	18 (17.6)	-
M stage
Stage 0	130 (58.0)	72 (59.0)	58 (56.9)	0.745
Stage 1	94 (42.0)	50 (41.0)	44 (43.1)	-

¹Comparison of the 122 hepatocellular caecinoma (HCC) patients with hepatitis B virus-related cirrhosis and 102 HCC patients without cirrhosis, using Pearson χ² tests because the total number of cases was more than 40 and no cells had an expected count less than 5. TNM: Tumor nodus metastasis; LC: Liver cirrhosis.

Table 3 Univariate analysis of factors associated with hepatocellular carcinoma and cirrhosis n (%)

Variable	Patients with LC1 (n = 122)	Patients without LC1 (n = 102)	P value2
Mean age (yr)	54.7 ± 10.0	54.6 ± 11.4	0.909
Male sex	106 (86.9)	84 (82.4)	0.346
Diabetes mellitus	19 (15.6)	8 (7.8)	0.077
Overweight or obesitya	54 (60.7)	41 (56.2)	0.562
Hypertension	33 (27.0)	26 (25.5)	0.792
Body weight (kg)	69.7 ± 11.4	67.7 ± 10.4	0.168
Body heighta (cm)	169.4 ± 6.2	169.5 ± 6.6	0.912
Mean body mass indexa (kg/m2)	24.1 ± 3.6	23.7 ± 3.1	0.441
Systolic blood pressure (mmHg)	128 ± 15	130 ± 16	0.323
Diastolic blood pressure (mmHg)	78 ± 9	79 ± 9	0.255
Mean artery pressure (mmHg)	95 ± 10	96 ± 10	0.243
Past history of HBV infection	103 (84.4)	70 (68.6)	0.005
Smoking	57 (46.7)	42 (41.2)	0.405
Alcohol intake	43 (35.2)	26 (25.5)	0.115
Positive for HBeAgb	32 (29.4)	20 (22.2)	0.254
HBV-DNAc, Log10	5.35 ± 1.37	5.26 ± 1.51	0.829
AFPd, > 400 ng/mL	59 (50.9)	51 (51.0)	0.984
Child-Pugh Score3	7 (6-10)	5 (5-6)	< 0.001
Blood glucose (mmol/L)	5.99 ± 2.44	5.73 ± 1.93	0.362
Total bilirubin3 (mg/L)	17 (9-31)	10 (8-17)	< 0.001
Albumin level (g/L)	34.8 ± 6.3	38.8 ± 5.6	< 0.001
International normalized ratio	1.31 ± 0.27	1.12 ± 0.15	< 0.001
Alanine aminotransferase3 (U/L)	58 (37-90)	45 (30-81)	0.050
γ glutamyl transferase3 (U/L)	110 (52-257)	117 (61-257)	0.816
Platelet count3 (× 109/L)	94 (61-152)	162 (115-217)	< 0.001
Triglyceridese (mmol/L)	1.02 ± 0.54	1.02 ± 0.49	0.995
Total cholesterole (mmol/L)	4.08 ± 1.44	4.53 ± 1.13	0.047
HDL cholesterolf (mmol/L)	0.89 ± 0.48	0.99 ± 0.38	0.152
LDL cholesterolf (mmol/L)	2.21 ± 1.10	2.78 ± 0.92	0.002
Creatinine3 (mg/dL)	0.9 (0.8-1.0)	0.9 (0.8-1.0)	0.839
Blood urea nitrogen3 (mmol/L)	4.95 (3.85-6.32)	5.02 (3.96-6.19)	0.927

¹Plus-minus value indicates mean ± SD;

²Comparison of the two groups, using independent-samples t-test, Mann-Whitney non-parametric U-test or Pearson χ² tests, respectively, depending on the categories of variables and different conditions. P < 0.05 was considered statistically significant and selected for multivariable analysis, including diabetes mellitus (DM) and alanine aminotransferase (ALT) with marginal differences;

³Median (inter-quartile range, Q1-Q3). Data were available in

^a162 (89 + 73),

^b199 (109 + 90),

^c57 (41 + 16),

^d216 (116 + 100),

^e148 (87 + 61) and

^f132 (79 + 53) patients. In the brackets, the numbers before the plus sign indicate the available cases in the group of patients with cirrhosis, whereas the latter indicate the cases in another group of patients without cirrhosis. AFP: α-fetoprotein; HBV: Hepatitis B virus; HDL: High-density lipoprotein; LC: Liver cirrhosis; LDL: Low-density lipoprotein.

Table 4 Multivariate analysis of factors associated with hepatocellular carcinoma and cirrhosis

Variable1	Adjusted OR	95% CI	P value
Diabetes mellitus	4.88	1.08-21.99	0.039
INR	117.14	4.19-3272.28	0.005
Albumin level	0.89	0.80-0.99	0.027
Platelet count	0.992	0.987-0.997	0.002

¹Nine variables were included in multivariable analysis, including diabetes, presence of past history of hepatitis B virus infection, total bilirubin, albumin, international normalized ratio, alanine aminotransferase, platelet count, total cholesterol, and low-density lipoprotein cholesterol. For better understanding of the role of Child-Pugh score, TBil, albumin and international normalized ratio (INR) were included as three independent variables and Child-Pugh score was excluded for dependence of variables. OR: Odds ratios; CI: Confidence interval.