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Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study

  • Dan Chen , Xiaoxiao Gao and Yaqing Wang EMAIL logo
Published/Copyright: January 10, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Background and aim

Liver cancer is a prevalent and life-threatening condition, particularly among elderly individuals. The association between diabetes, a chronic metabolic disorder, and the onset and advancement of liver cancer has been widely acknowledged. However, the effect of diabetes on the survival of older patients with liver cancer has been a topic of debate. In light of this, we undertook a retrospective study to assess the impact of diabetes on the overall survival (OS) of elderly individuals diagnosed with liver cancer.

Methods

In this retrospective analysis, we examined clinical data from liver cancer patients aged 80 years or older who underwent diagnosis and treatment at a solitary medical center from January 2010 to December 2019. Comprehensive records encompassing baseline information, treatment protocols, diabetes history, and mortality during follow-up were meticulously documented. Employing the Kaplan–Meier method and the Cox proportional hazards model, we sought to assess the influence of diabetes on both the OS and recurrence-free survival (RFS) in elderly individuals diagnosed with liver cancer.

Results

This study comprised 244 elderly liver cancer patients, with 68 individuals reporting a history of diabetes. In the unadjusted Kaplan–Meier survival analysis, the diabetes group exhibited a lower OS compared to the non-diabetes group. Utilizing a multivariate Cox proportional hazards model, diabetes emerged as a prognostic factor influencing OS (hazard ratio, HR = 1.782 [1.163–2.743], P = 0.043). Regarding RFS, unadjusted Kaplan–Meier analysis revealed a diminished RFS in the diabetes group compared to the non-diabetes group. In the multivariate Cox proportional hazards model, diabetes remained a significant prognostic factor impacting RFS (HR = 1.742 [1.083–1.546], P = 0.041).

Conclusion

Our study indicates a significant impact of diabetes on both OS and RFS among elderly liver cancer patients. These insights may contribute to more precise guidance and recommendations for the treatment of this specific demographic, offering valuable information for healthcare practitioners working with elderly individuals diagnosed with liver cancer.

Keywords: diabetes; liver cancer; elderly; prognosis

1 Introduction

Liver cancer poses a significant global public health challenge [1], with an estimated 841,000 new cases and 782,000 deaths reported in 2020 [2,3]. The incidence of liver cancer rises with age, and elderly individuals face an elevated risk of developing this condition, attributed to the cumulative impact of environmental and genetic risk factors [4]. Moreover, diabetes, characterized by persistent high blood glucose levels, has been recognized as an independent risk factor for liver cancer [5,6].

The correlation between diabetes and liver cancer among elderly patients has been extensively explored in recent years. Multiple studies have indicated that diabetes is linked to an elevated incidence and increased mortality of liver cancer in the elderly population [7,8]. A meta-analysis of 26 cohort studies revealed a 43% increase in the risk of liver cancer associated with diabetes in the general population [9]. Additionally, an independent study highlighted that diabetes was specifically correlated with a higher risk of liver cancer mortality in elderly men [10]. Furthermore, a retrospective study demonstrated a significant association between diabetes and compromised overall survival (OS) as well as disease-free survival in elderly patients diagnosed with hepatitis B virus-related hepatocellular carcinoma (HCC) [11] Concurrently, Kramer and Natarajan [12] emphasized the importance of adequate glycemic control, concluding that reasonable glycemic control could reduce the risk of HCC by 31% in patients with nonalcoholic fatty liver disease (NAFLD).

Nevertheless, not all studies have consistently observed a significant association between diabetes and the survival outcomes in elderly patients with liver cancer. A substantial cohort study, encompassing over 10,000 patients, reported no noteworthy difference in OS between individuals with and without diabetes who were diagnosed with liver cancer. Similarly, a retrospective study found no association between diabetes and prognosis in elderly patients specifically with HCC.

As a result, the impact of diabetes on the survival of elderly patients with HCC and the extent of this impact remain subjects of controversy. In an effort to contribute clarity to this issue, we conducted a retrospective study to evaluate the influence of diabetes on the survival of elderly patients with liver cancer. Our findings aim to offer more precise guidance and recommendations for the treatment of elderly individuals grappling with liver cancer.

2 Materials and methods

2.1 Patient selection

This retrospective study encompassed all elderly patients aged 80 years or older diagnosed with liver cancer and treated at the Department of Hepatobiliary Surgery, a single medical center in China, during the period from January 2010 to December 2019. To ensure data integrity, patients with incomplete clinical information or those who had initiated treatment before their initial hospital visit were excluded from the study.

The diagnostic criteria for type 2 diabetes, following the guidelines of the World Health Organization and International Diabetes Federation, required meeting one of the following conditions: a fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL); a random plasma glucose level ≥ 11.1 mmol/L (200 mg/dL) with diabetes symptoms such as polyuria, polydipsia, or fatigue; or a 2-h plasma glucose level ≥ 11.1 mmol/L (200 mg/dL) during a 75 g oral glucose tolerance test.

Strict inclusion criteria were applied: (1) patients aged 80 years or older at the time of diagnosis; (2) confirmed diagnosis of primary liver cancer through pathological examination or radiological findings; and (3) initial detection of liver cancer. Exclusion criteria comprised: (1) incomplete clinical data, including missing laboratory results or imaging studies; (2) previous liver cancer treatment before the initial hospital visit; and (3) diagnosis of other malignancies before or after liver cancer.

Approval for this retrospective study was obtained from the Ethics Committee of The Fourth Affiliated Hospital of Nanjing Medical University, adhering to the principles outlined in the Declaration of Helsinki. Informed consent was provided by all patients. Imaging examinations, such as computed tomography (CT)/magnetic resonance imaging (MRI), were conducted, and liver cancer diagnosis was confirmed by two experienced radiologists. Surgical treatment cases were pathologically verified for liver cancer based on postoperative pathology.

2.2 Follow-up

All patients were subject to continuous follow-up until either death or the conclusion of the study on February 28, 2023. Follow-up appointments were scheduled every 3 months for the initial year post-diagnosis, transitioning to every 6 months thereafter. During each follow-up visit, a comprehensive assessment was conducted, encompassing physical examinations, blood tests (including liver function tests and alpha-fetoprotein [AFP] levels), and imaging studies such as ultrasound, CT, MRI, and positron emission tomography, as deemed necessary. This rigorous follow-up protocol ensured thorough monitoring and evaluation of each patient’s health status throughout the study duration.

2.3 Clinical data collection

From electronic medical records, we retrospectively gathered the following data: demographic characteristics (age, sex), diabetes status, liver function test results (including alanine transaminase [ALT], aspartate transaminase [AST], albumin [ALB], total bilirubin [TBIL], and prothrombin time [PT], serum AFP levels), tumor stage (as per the Barcelona Clinic Liver Cancer staging system), treatment regimens (covering surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization, and supportive care), and mortality recorded during the follow-up period. Diabetes status was confirmed based on a documented history of diabetes or the use of hypoglycemic agents. This comprehensive dataset allowed for a thorough analysis of various factors influencing the outcomes of elderly patients with liver cancer.

2.4 Data analysis

Continuous variables, assuming a normal distribution, are expressed as mean value ± standard deviation, and differences between them are assessed using the T-test. Categorical variables are compared between two groups using either the Chi-square test or Fisher’s exact test. For the generation of OS and recurrence-free survival (RFS) curves, the Kaplan–Meier method was employed, with survival curve comparisons executed using the log-rank test. To evaluate the impact of diabetes on OS and PFS while adjusting for potential confounding factors such as age, sex, AFP levels, tumor stage, treatment regimens, and liver function tests, the Cox proportional hazards model was applied.

All statistical analyses were conducted using SPSS 25.0 (IBM, Armonk, New York, USA), with a significance level set at P < 0.05 (two sides). Graphical representations were created using R language (version 4.0.5) and GraphPad Prism (version: 8.0). Sample size estimation was performed using PASS (version: 11.0) before the initiation of the study.

  1. Ethics approval and consent to participate: This research was performed in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of The Fourth Affiliated Hospital of Nanjing Medical University. All patients provided informed consent.

  2. Informed consent: Written informed consent for publication was obtained.

3 Results

3.1 Baseline information of liver cancer patients with and without diabetes

The inclusion and exclusion criteria for patients are comprehensively outlined in Figure 1. Patients with diabetes exhibited a mean age of 84 ± 3.2 years, which was significantly higher than their non-diabetic counterparts (82 ± 4.0 years, P = 0.032). Both groups displayed a similar gender distribution, with 54.4% of diabetic patients being male and 60.8% of non-diabetic patients being male (P = 0.402). The majority of patients in both groups had cirrhosis (82.4% of diabetic patients and 84.1% of non-diabetic patients), with no significant difference observed between the two groups (P = 0.758). Similar Eastern Cooperative Oncology Group (ECOG) performance status was noted in both groups, with 86.8% of diabetic patients and 84.1% of non-diabetic patients having an ECOG score of 0–1 (P = 0.758).

Figure 1 Inclusion and exclusion table for HCC patients.
Figure 1

Inclusion and exclusion table for HCC patients.

Patients with diabetes exhibited slightly higher levels of ALT (36.8 ± 10.5 U/L) compared to those without diabetes (34.2 ± 8.6 U/L, P = 0.103). However, there was no significant difference in AST levels between the two groups (P = 0.387). Non-diabetic patients demonstrated higher levels of serum ALB (42.5 ± 3.2 g/L) compared to diabetic patients (40.8 ± 3.8 g/L, P = 0.012). No significant differences were observed in TBIL or PT levels between the two groups (P = 0.412 and P = 0.246, respectively). The proportion of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections did not differ statistically between the two groups. The serum AFP level of diabetic patients was essentially similar to that of non-diabetic patients (P = 0.053), and among diabetic patients, 31 (45.6%) had AFP levels exceeding 400 ng/mL (Table 1).

Table 1

Baseline characteristics of patients with gastric cancer undergoing gastrectomy in the training and validation cohorts (n = 244)

Diabetes (n = 68) No diabetes (n = 176) P-value
Gender (%) 0.402
Male 37 (54.4) 107 (60.8)
Female 31 (45.6) 69 (39.2)
Age (years) 82 ± 3.2 80 ± 4.0 0.032
ASA (%) 0.307
I 217 (88.6) 94 (84.7)
II 28 (11.4) 17 (15.3)
ECOG PS (%) 0.758
0–1 59 (86.8) 148 (84.1)
2–3 12 (17.6) 28 (15.9)
ALT U/L 36.8 ± 10.5 34.2 ± 8.6 0.103
AST U/L 30.3 ± 7.3 29.1 ± 6.2 0.387
ALB g/L 40.8 ± 3.8 42.5 ± 3.2 0.012
TBIL μmol/L 14.7 ± 3.3 14.3 ± 3.1 0.412
PT s 16.1 ± 1.9 15.9 ± 1.7 0.246
AFP (%) 0.053
≤400 ng/mL 37 (54.4) 120 (68.2)
>400 ng/mL 31 (45.6) 56 (31.8)
Cirrhosis status 0.758
Yes 56 (82.4) 148 (84.1)
No 12 (17.6) 28 (15.9)
HBV 1.000
Yes 60 (88.2) 155 (88.1)
No 8 (11.8) 21 (11.9)
HCV 1.000
Yes 3 (4.4) 7 (4.0)
No 65 (95.6) 169 (96.0)
BCLC stage (%) 0.826
A 46 (67.6) 118 (67.0)
B 12 (17.6) 36 (15.3)
C 10 (14.7) 22 (18.0)
Tumor size (%) 0.565
<5 cm 36 (52.9) 102 (58.0)
≥5 cm 32 (47.1) 74 (42.0)
Tumor number (%) 1.000
Single 46 (64.7) 118 (67.0)
Multiple 22 (35.3) 58 (33.0)
Treatment regimens (%) 0.697
Resection 20 (29.4) 56 (31.8)
RFA 16 (23.5) 40 (22.7)
TACE 24 (35.3) 60 (34.1)
Supportive care 8 (11.8) 20 (11.4)
Fasting plasma glucose level mmol/L 9.3 ± 2.1 5.1 ± 0.9 <0.001
Random plasma glucose level mmol/L 11.1 ± 2.2 6.2 ± 0.8 <0.001
2-h plasma glucose level mmol/L 15.2 ± 2.8 7.4 ± 1.4 <0.001

SD: standard deviation; ALT: alanine transaminase; AST: aspartate transaminase; ALB: albumin; TBIL: total bilirubin; PT: prothrombin time; AFP: alpha-fetoprotein; IQR: interquartile range; RFA: radiofrequency ablation; TACE: transcatheter arterial chemoembolization; ECOG: Eastern Cooperative Oncology Group.

3.2 Univariate and multivariate Cox proportional hazard regression analyses of OS in liver cancer patients

In the univariate analysis, male gender (HR = 1.211, P = 0.028), cirrhosis status (HR = 1.433, P = 0.014), ECOG performance status (HR = 1.925, P = 0.003), diabetes status (HR = 3.220, P < 0.001), higher levels of ALT (HR = 1.012, P = 0.024), larger tumor size (HR = 1.538, P < 0.001), multiple tumors (HR = 2.034, P < 0.001), and later tumor stage (HR = 1.271, P = 0.024) were associated with worse OS. However, in the multivariate analysis, adjusting for other covariates revealed that only tumor size (HR = 1.423, P < 0.001), number of tumors (HR = 1.813, P < 0.001), diabetes status (HR = 1.782, P = 0.043), and treatment regimen (resection/supportive care: HR = 0.617, 95% CI = 0.388–0.972, P = 0.038) remained significantly correlated with OS (Table 2).

Table 2

Univariate and multivariate analysis of OS in liver cancer patients in the whole cohort

Univariate analysis Multivariate analysis
P HR 95% CI P HR 95% CI
Gender
Male/female 0.028 1.211 1.031–1.423 0.726 0.920 0.651–1.297
Age
Per years 0.852 0.972 0.705–1.364
Cirrhosis status
Yes/No 0.014 1.433 1.098–1.887 0.086 1.313 0.985–1.766
ECOG PS
0–1/2–3 0.003 1.925 1.287–2.871 0.021 1.677 1.093–2.563
Diabetes status
Yes/No <0.001 3.220 2.352–4.441 0.043 1.782 1.163–2.743
ALT
Per U/L 0.024 1.012 1.002–1.018 0.045 1.023 1.005–1.032
AST
Per U/L 0.077 1.021 0.988–1.042
ALB
Per g/L 0.102 0.792 0.618–1.132
TBIL
Per μmol/L 0.029 1.012 1.004–1.023 0.267 1.012 0.991–1.027
Tumor size
≥5 cm/<5 cm <0.001 1.538 1.274–1.846 <0.001 1.423 1.161–1.745
Tumor number
Multiple/Single <0.001 2.034 1.492–2.778 <0.001 1.813 1.302–2.524
Tumor stage
BCLC B/BCLC A 0.024 1.271 1.031–1.567 0.073 1.213 0.987–1.492
Treatment regimens 0.006 0.038
Resection/supportive care 0.551 0.361–0.843 0.617 0.388–0.972
RFA/supportive care 0.682 0.441–1.062

ALT: alanine transaminase; AST: aspartate transaminase; ALB: albumin; TBIL: total bilirubin; AFP: alpha-fetoprotein; RFA: postoperative adjuvant radiofrequency ablation; TACE: postoperative adjuvant transcatheter arterial chemoembolization; ECOG: Eastern Cooperative Oncology Group.

3.3 Univariate and multivariate Cox proportional hazard regression analyses of RFS in liver cancer patients who underwent radical treatment

The univariate analysis indicates that cirrhosis status (HR = 1.389, P = 0.023), diabetes status (HR = 3.192, P < 0.001), larger tumor size (HR = 1.475, P < 0.001), multiple tumors (HR = 2.153, P < 0.001), later tumor stage (HR = 1.301, P = 0.013), and treatment regimen (resection/radiofrequency ablation [RFA]: HR = 0.788, 95% CI = 0.534–0.910, P = 0.006) were significantly associated with RFS. In the multivariate analysis, after adjusting for other covariates, only cirrhosis status (HR = 1.441, 95% CI = 1.058–1.741, P = 0.132), diabetes status (HR = 1.742, 95% CI = 1.083–1.546, P = 0.041), tumor size (HR = 1.318, 95% CI = 1.073–1.618, P = 0.033), tumor number (HR = 2.431, 95% CI = 1.812–3.170, P = 0.041), tumor stage (HR = 1.416, 95% CI = 1.178–1.862, P = 0.019), and treatment regimen (HR = 0.865, 95% CI = 0.613–0.943, P = 0.016) remained significantly correlated with RFS. Patients with cirrhosis or diabetes faced a higher risk of recurrence, while those with larger tumor sizes, multiple tumors, and later tumor stage were also associated with an elevated risk of recurrence. Notably, patients who underwent resection exhibited better RFS outcomes compared to those who received RFA (Table 3).

Table 3

Univariate and multivariate analysis of RFS in liver cancer patients with radical treatment (surgical and RFA) in the whole cohort

Univariate analysis Multivariate analysis
P HR 95% CI P HR 95% CI
Gender
Male/female 0.113 1.105 0.881–1.343
Age
Per years 0.718 0.873 0.648–1.271
Cirrhosis status
Yes/No 0.023 1.389 1.134–1.912 0.132 1.441 1.058–1.741
ECOG PS
0–1/2–3 0.138 1.742 0.868–2.472
Diabetes status
Yes/No <0.001 3.192 2.034–5.031 0.041 1.742 1.083–1.546
ALT
Per U/L 0.121 1.008 0.972–1.142
AST
Per U/L 0.065 1.017 0.989–1.134
ALB
Per g/L 0.213 0.812 0.712–1.488
TBIL
Per μmol/L 0.210 1.078 0.852–1.166
Tumor size
≥5 cm/<5 cm <0.001 1.475 1.246–1.952 0.033 1.318 1.073–1.618
Tumor number
Multiple/single <0.001 2.153 1.774–2.913 0.041 2.431 1.812–3.170
Tumor stage
BCLC B/BCLC A 0.013 1.301 1.078–1.611 0.019 1.416 1.178–1.862
Treatment regimens
Resection/RFA 0.006 0.788 0.534–0.910 0.016 0.865 0.613–.943

ALT: alanine transaminase; AST: aspartate transaminase; ALB: albumin; TBIL: total bilirubin; AFP: alpha-fetoprotein; RFA: postoperative adjuvant radiofrequency ablation; TACE: postoperative adjuvant transcatheter arterial chemoembolization; ECOG: Eastern Cooperative Oncology Group.

3.4 Complications in HCC patients in the diabetic group vs the non-diabetic group

During the follow-up period, in the diabetic group, there were six deaths (8.8% of total patients) in the diabetic group, while there were five deaths (2.8% of total patients) in the non-diabetic group. The difference between the two groups was not statistically significant (P = 0.077).

In addition, liver failure occurred in three cases (4.4% of total patients) in the diabetic group, while only two cases (1.1% of total patients) occurred in the non-diabetic group. Lung infection occurred in five cases (7.4% of total patients) in the diabetic group, while only two cases (1.1% of total patients) occurred in the non-diabetic group. These differences were statistically significant between the two groups (P < 0.05).

Furthermore, with regard to distant metastasis of HCC, two cases (2.9% of total patients) were observed in the diabetic group, compared to one case (0.6% of total patients) in the non-diabetic group. However, there were no significant differences between the two groups in terms of other complications such as hydrocephalus, cardiovascular, and cerebrovascular events (P > 0.05) (Table 4).

Table 4

Complications during hospitalization in patients with hepatocellular carcinoma in the diabetic group vs the non-diabetic group

Diabetes (n = 68) No diabetes (n = 176) P-value§
Number of deaths, n (%)† 6 (8.8) 5 (2.8) 0.077
Liver failure, n (%) 3 (4.4) 2 (1.1) 0.134
Hydrocephalus, n (%) 2 (2.9) 1 (0.6) 0.189
Lung infection, n (%) 5 (7.4) 2 (1.1) 0.019
Distant metastasis of liver cancer*, n (%) 2 (2.9) 1 (0.6) 0.189
Cardiovascular accidents, n (%) 1 (1.5) 1 (0.6) 0.481
Cerebrovascular accidents, n (%) 1 (1.5) 1 (0.6) 0.481
Tumor recurrence, n (%)‡ 51 (75.0) 105 (59.7) 0.026

†Patient died within 90 days after admission. *After radical treatment. ‡Patients with recurrence by the time of the last follow-up. §Using the chi-square test or Fisher’s exact probability test.

3.5 Prognosis of elderly HCC patients in the group with diabetes vs the group without diabetes

In terms of OS, HCC patients with type 2 diabetes exhibited OS rates at 1, 3, and 5 years of 63.9, 16.7, and 0.0%, respectively, with a median survival time of 22.0 months. Conversely, for HCC patients without type 2 diabetes, the OS rates at 1, 3, and 5 years were 100.0, 78.1, and 61.5%, respectively, with a median survival time of 84.0 months.

For HCC patients who underwent radical treatment, the 1-, 3-, and 5-year relapse-free survival rates for those with and without diabetes were 69.4, 7.1, and 0.0%, and 81.1, 55.5, and 40.0%, respectively (Figure 2).

Figure 2 Prognostic survival of elderly HCC patients in the diabetic and non-diabetic groups. (a) represents OS for all patients and (b) represents RFS for patients receiving radical treatment.
Figure 2

Prognostic survival of elderly HCC patients in the diabetic and non-diabetic groups. (a) represents OS for all patients and (b) represents RFS for patients receiving radical treatment.

3.6 Efficacy of different glucose metrics to predict 5-year survival

Receiver operating characteristic (ROC) curves were employed to illustrate the predictive efficacy of various glucose metrics for elderly HCC patients. The ROC curves for fasting plasma glucose level, random plasma glucose level, and 2 h plasma glucose level were plotted, where the horizontal axis represents 1-specificity and the vertical axis denotes sensitivity. The area under the curve (AUC) was determined to assess the discriminatory power of each metric. Specifically, the AUC values were 0.724 for fasting plasma glucose level, 0.666 for random plasma glucose level, and 0.688 for 2 h plasma glucose level (Figure 3).

Figure 3 Fasting plasma glucose level, random plasma glucose level, and 2-h plasma glucose level of the ROC.
Figure 3

Fasting plasma glucose level, random plasma glucose level, and 2-h plasma glucose level of the ROC.

4 Discussion

HCC represents a significant and escalating public health concern, marked by a rise in both incidence and mortality rates on a global scale. This concerning trend is primarily attributed to human activities that have modified the environment and lifestyle, fostering the accumulation of HCC risk factors. These risk factors encompass unhealthy dietary habits, excessive alcohol consumption, viral infections, genetic predispositions, and metabolic abnormalities [13,14]. The elderly population faces a heightened susceptibility to HCC compared to other age groups, primarily due to prolonged exposure to HCC risk factors such as persistent alcohol consumption or past hepatitis virus infections. Additionally, the gradual decline in organ function, a weakened immune system, and diminished cellular repair capabilities in the elderly contribute to accelerated physical degeneration and damage, rendering them more prone to the development of HCC.

Recent studies have emphasized that diabetes mellitus (DM) stands as one of the risk factors for HCC in the elderly [15]. With over 400 million individuals worldwide affected by DM, these patients face an elevated risk of various metabolic disorders, including liver diseases and HCC. As highlighted by Onikanni and colleagues [16], a connection exists between Type 2 DM (T2DM) and liver cancer. However, the underlying pathological and physiological mechanisms linking T2DM to HCC are multifaceted, involving associations with various conditions such as NAFLD, heightened hepatic insulin resistance, hyperinsulinemia, activation of pro-inflammatory mediators, oxidative stress, JNK-1 activation, increased IGF-1 activity, alterations in gut microbiota, and immune regulation [17,18]. Significantly, the robust association between DM and HCC extends not only to the elderly population but also to the general population. These findings underscore the necessity for heightened attention to the impact of DM on the occurrence and progression of HCC in the elderly, given their elevated incidence of DM and prolonged exposure to HCC risk factors.

Our study underscores the significant impact of T2DM on the long-term prognosis of elderly liver cancer patients, elevating both their risk of mortality and recurrence. Bragg’s prospective investigation involving 510,000 individuals across ten regions in China revealed an association between diabetes and liver cancer mortality (RR = 1.54 [95% CI, 1.28–1.86]). Similarly, Onikanni et al. [16] analyzed data from 97 prospective studies, encompassing 820,900 individuals globally, and identified a moderate association between diabetes (vs non-diabetes) and deaths related to liver, pancreatic, ovarian, colorectal, lung, stomach, and breast cancers – consistent with our study’s findings. In our investigation, T2DM exhibited a stronger correlation with OS in elderly HCC patients (HR = 3.220 [2.352–4.441]). Therefore, HCC emerges not only as a significant cause of mortality in diabetic patients but also as a noteworthy comorbidity that cannot be overlooked. Consequently, there is a call for enhanced interventions in clinical practice for elderly liver cancer patients, including the implementation of routine blood glucose-lowering therapy.

Diabetes is also a factor in the progression of liver disease [19]. Angulo et al. [20] concluded that diabetes is a significant predictor of severe liver fibrosis, while the risk of causing liver disease to progress to HCC increases with increasing duration of diabetes, with a multivariate HR of 2.96 (95% CI, 1.57–5.60) for HCC with a duration of diabetes < 2 years, 6.08 (95% CI, 2.96–12.50) < 10 years and 7.52 (95% CI, 3.88–14.58) for patients with DM ≥ 10 years, so the risk of HCC development in patients with cirrhosis in the presence of long-term DM should be tested with emphasis.

Our study has certain limitations, first, the study is a retrospective study, so selection bias and confounding bias are inevitable; second, the duration of illness of the diabetic patients we included was not discussed in subgroups, and further discussion on the duration of illness in type 2 diabetic patients should be conducted in the future; and finally, the sample size should be further expanded and multicenter data should be added to improve the external applicability of the findings.

5 Conclusion

Our study highlights the considerable impact of diabetes on OS and RFS in elderly patients with liver cancer. These findings have the potential to offer more precise guidance and recommendations for the treatment of elderly patients grappling with liver cancer. Moreover, the diabetic group exhibited a higher incidence of complications, underscoring the importance of directing attention toward elderly HCC patients with diabetes.

Acknowledgements

Thanks to the nurses in the department for their help with the project.

  1. Funding information: The authors state no funding involved.

  2. Author contributions: D.C. wrote the paper. X.X.G. provided the ideas. Y.Q.W. and D.C. reviewed the manuscript. All authors read and approved the manuscript.

  3. Conflict of interest: The authors state no conflict of interest.

  4. Data availability statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2024-05-13
Revised: 2024-10-20
Accepted: 2024-11-03
Published Online: 2025-01-10

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Review Articles
  118. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  119. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  120. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  121. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  122. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  123. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  124. The application of augmented reality in robotic general surgery: A mini-review
  125. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  126. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  127. Plant polyphenols, terpenes, and terpenoids in oral health
  128. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  129. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  130. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  131. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  132. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  133. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  134. Giant borderline ovarian tumours – review of the literature
  135. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  136. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  137. Case Reports
  138. Delayed graft function after renal transplantation
  139. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  140. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  141. Giant right atrial hemangioma presenting with ascites: A case report
  142. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  143. Rapid Communication
  144. Biological properties of valve materials using RGD and EC
  145. Letter to the Editor
  146. Role of enhanced external counterpulsation in long COVID
  147. Expression of Concern
  148. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  149. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  150. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  151. Corrigendum
  152. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  153. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  154. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  155. Retraction
  156. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  157. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  158. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  159. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  160. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  161. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  162. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  163. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  164. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  165. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  166. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  167. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  168. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  169. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  170. Special Issue Diabetes
  171. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  172. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  173. Special Issue Biomarker Discovery and Precision Medicine
  174. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
https://doi.org/10.1515/med-2024-1096
Keywords for this article
diabetes; liver cancer; elderly; prognosis
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Review Articles
  118. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  119. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  120. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  121. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  122. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  123. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  124. The application of augmented reality in robotic general surgery: A mini-review
  125. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  126. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  127. Plant polyphenols, terpenes, and terpenoids in oral health
  128. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  129. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  130. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  131. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  132. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  133. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  134. Giant borderline ovarian tumours – review of the literature
  135. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  136. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  137. Case Reports
  138. Delayed graft function after renal transplantation
  139. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  140. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  141. Giant right atrial hemangioma presenting with ascites: A case report
  142. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  143. Rapid Communication
  144. Biological properties of valve materials using RGD and EC
  145. Letter to the Editor
  146. Role of enhanced external counterpulsation in long COVID
  147. Expression of Concern
  148. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  149. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  150. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  151. Corrigendum
  152. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  153. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  154. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  155. Retraction
  156. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  157. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  158. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  159. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  160. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  161. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  162. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  163. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  164. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  165. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  166. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  167. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  168. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  169. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  170. Special Issue Diabetes
  171. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  172. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  173. Special Issue Biomarker Discovery and Precision Medicine
  174. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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