Association of type 2 diabetes mellitus with hepatocellular carcinoma and alpha fetal protein

Objective To investigate the relationship of type 2 diabetes mellitus with hepatocellular carcinoma (HCC) and alpha fetal protein (AFP). Methods A total of 508 patients [(59±12) years old, 406 males (79.92%)] with HCC from January 2010 to December 2016 were retrospectively evaluated. All patients were divided into type 2 diabetic group (n=233) and non-diabetic group (n=275). Fasting blood glucose, liver function and AFP level were compared and analyzed. Liver function was assessed according to the Child-Pugh classification criteria (Grade A, B and C). The pathological grade of hepatocellular carcinoma was divided according to Edmondson-Steiner pathology (Grade 1, 2, 3 and 4). The cancer stage of HCC was obtained at the time of diagnosis based on the Barcelona Clinic Liver Cancer classification (stage 0, 1, 2, 3 and 4). Patients were further divided into different groups based on age:<50 years, 50-59 years, 60-69 years and ≥70 years. The multivariate linear regression, multivariate logistic regression and covariance analysis were applied to investigate the relationship of type 2 diabetes with AFP in HCC. Results Compared to non-diabetic group, the diabetic group had higher negative rate of AFP [54.51% (127/233) vs 37.82% (104/275), χ2=14.17, P<0.001] and worse liver function (χ2=9.60, P=0.012). Serum AFP level in type 2 diabetics was remarkably lower than that in non-diabetics [11 (4-249) vs 89 (8-1 132) μg/L, Z=-4.32, P<0.001]. After adjustment for age, the AFP level in type 2 diabetics was still significantly lower than that in non-diabetics (H=10.15, P=0.002). Type 2 diabetes was significantly correlated with increased incidence risk of high-grade (grade 3 and 4) HCC (OR=1.80, 95%CI 1.08-3.00, P=0.025). In the HCC patients, the serum level of AFP was negatively correlated with age and T2DM (β=-0.151, P=0.001; β=-0.162, P=0.003). Conclusion Type 2 diabetes mellitas contributes to lower serum AFP level and worse liver function, which is more likely to delay and interfere with HCC diagnosis, leading to higher malignant degree of HCC. Key words: Diabetes mellitus, type 2; Liver neoplasms; alpha-Fetoproteins