Homeostatic Model Assessment of Insulin Resistance for Predicting the Recurrence of Hepatocellular Carcinoma after Curative Treatment

Abstract

Diabetes mellitus (DM) is a risk factor for hepatocellular carcinoma (HCC). The purpose of this study was to investigate the impact of the disorder of glucose metabolism on the recurrence of HCC after curative treatment. Two hundred and eleven patients with HCC who received curative treatment in our hospital from 2006 to 2017 were enrolled in this study. Recurrence-free survival was estimated using the Kaplan⁻Meier method, and the differences between the groups partitioned by the presence or absence of DM and the values of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), fasting immunoreactive insulin (FIRI), and homeostasis model assessment-insulin resistance (HOMA-IR) were evaluated using the log-rank test. There were no significant differences in the recurrence-free survival rate between the patients with and without DM (p = 0.144), higher and lower levels of HbA1c (≥6.5 and <6.5%, respectively; p = 0.509), FPG (≥126 and <126 mg/dL, respectively; p = 0.143), and FIRI (≥10 and <10 μU/mL, respectively; p = 0.248). However, the higher HOMA-IR group (≥2.3) had HCC recurrence significantly earlier than the lower HOMA-IR group (<2.3, p = 0.013). Moreover, there was a significant difference between the higher and lower HOMA-IR groups without DM (p = 0.009), and there was no significant difference between those groups with DM (p = 0.759). A higher HOMA-IR level, particularly in non-diabetic patients, was a significant predictor for HCC recurrence after curative treatment.

Keywords: Hepatocellular carcinoma; diabetes mellitus; homeostasis model assessment-insulin resistance (HOMA-IR); insulin resistance; recurrence risk.

Figure 1

Kaplan–Meier curves for recurrence-free survival time in patients with and without diabetes mellitus.

Figure 2

Kaplan–Meier curves for recurrence-free survival time divided into higher and lower (≥6.5 and <6.5%, respectively) hemoglobin A1c (HbA1c) groups (a), higher and lower (≥126 and <126 mg/dL, respectively) fasting plasma glucose (FPG) groups (b), higher and lower (≥10 and <10 μU/mL, respectively) fasting immunoreactive insulin (FIRI) groups (c), and higher and lower (≥2.3 and <2.3, respectively) homeostasis model assessment-insulin resistance (HOMA-IR) groups (d).

Figure 3

Kaplan–Meier curves for recurrence-free survival time divided into higher and lower (≥2.3 and <2.3, respectively) homeostasis model assessment-insulin resistance (HOMA-IR) groups without (a) or with diabetes mellitus (DM) (b).