Abstract: Objective:To investigate the related factors of early liver cancer recurrence associated with elevated fasting glucose levels after radical resection of liver cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 145 patients with liver cancer who were admitted to the Nanfang Hospital of Southern Medical University from October 2009 to June 2013 were collected. After radical resection of liver cancer, 111 patients with average level of fasting blood glucose (FBG)<6.1 mmol/L and 34 patients with level of FBG≥ 6.1 mmol/L were divided into the normal group and the hyperglycemic group, respectively. The blood glucose levels of patients during the period of hospital stay and followup were observed. The status of early recurrence and risk factors affecting recurrence in the 2 groups were analyzed. Followup of outpatient examination was applied to patients up to July 1, 2015 with the first recurrence as the end point. Patients had reexaminations once every month within postoperative month 6 and once every 3 months after 6 months. The general information ［gender, age, FBG,underlying hepatopathy, preoperative AFP, alanine transaminase (ALT), aspartate aminotransferase (AST), ChildPugh stage, Barcelona Clinic Liver Cancer (BCLC) stage, history of alcohol drinking］, surgical data (surgical method, operation time, number of blood transfusion, volume of intraoperative blood loss), pathological data (histopathological differentiation, number of tumor nodules, diameter of maximal tumor, liver cirrhosis) and followup data(postoperative AFP, imaging findings, recurrence time, preventive chemotherapy) were collected. Measurement data with normal distribution were presented as ±s and analyzed by the t test. Measurement data with skewed distribution were presented as M (range) and analyzed by the nonparametric test. Count data were analyzed using the chisquare test. With the first recurrence as the end point, the tumorfree survival rate was drawn using the KaplanMeier method, and the comparison was analyzed by the logrank test. The risk factors affecting recurrence were analyzed using the KaplanMeier method for proportional hazards assumption test firstly, and then eligible factors were done using Logrank test in the univariate analysis. The multivariate analysis was done using the COX model.
Results:The postoperative  1, 2year overall recurrence rates of liver cancer were 28.3%(41/145) and 45.5%(66/145). And 1, 2year  recurrence rates of liver cancer were 21.6%(24/111) and 36.9%(41/111) in the normal group and 50.0% (17/34) and 73.5% (25/34) in the hyperglycemic group, respectively, showing significant differences between the 2 groups (χ²= 10.335, 14.053, P<0.05). The univariate analysis showed that FBG, ChildPugh stage, volume of intraoperative blood transfusion and postoperative AFP were risk factors affecting tumorfree survival rate after radical resection of liver cancer (χ²=17.591, 6.492, 10.690,12.820, P<0.05). The tumorfree survival rates at postoperative month 24 in the normal group and hyperglycemic group were 63.1% and 26.5% respectively, showing significant difference between the 2 groups (χ²=17.591, P<0.05). The results of multivariate analysis showed that level of FBG≥6.1 mmol/L, volume of intraoperative blood transfusion>200 mL and postoperative level of AFP>8.1 μg/L were independent risk factors affecting tumorfree survival rate after radical resection of liver cancer (RR=2.542, 2.028, 2.724, 95% condifence interval: 1.529-4.225,1.183-3.479,1.635-4.538, P<0.05).
Conclusions:Elevated FBG level has a stimulative effect on early recurrence of tumor after radical resection of liver cancer. As a result, monitoring and controlling of blood glucose after operation is helpful in decreasing the early recurrence rate of patients with liver cancer.