Early-stage hepatocellular carcinoma (HCC) is still difficult to cure for its high recurrence rate. This study aimed to examine whether glycemic burden management could be one way to improve outcomes of early-stage HCC. A total of 137 very early or early-stage HCC patients who underwent resection or ablation at Samsung Medical Center and had glycemic burden assessment were analyzed. Glycemic burden was assessed using hemoglobin A1c (HbA1c) level. Outcomes were recurrence and overall survival. Risks of recurrence and overall survival were compared according to glycemic burden using a cut-off point of 6.5% or two cut-off points of 6.0% and 7.5%. Overall, 51 (37.2%) patients experienced HCC recurrence. The adjusted hazard ratio (aHR) for recurrence comparing patients with HbA1c > 6.5% to those with HbA1c ≤ 6.5% was 2.66 (95% CI: 1.26–5.78). The risk of recurrence increased in a dose-dependent manner by glycemic burden; aHR for 6.0 < HbA1c ≤ 7.5%: 2.00 (95% CI: 0.78–5.55); aHR for HbA1c > 7.5%: 6.05 (95% CI: 2.31–17.5). Mortality was observed in 16 (11.7%) patients. The risk of mortality was higher for HbA1c > 6.5% than for HbA1c ≤ 6.5% (aHR: 2.33; 95% CI: 1.10–5.08). There was also a dose–response relationship between overall survival and glycemic burden. Glycemic burden assessed using HbA1c level was significantly associated with outcomes of early-stage HCC patients. Good glycemic control could be a therapeutic goal to improve clinical outcomes in these populations.
早期肝细胞癌（HCC）因其高复发率仍难以治愈。本研究旨在探讨血糖负荷管理是否可作为改善早期HCC预后的途径之一。研究分析了在三星医疗中心接受切除或消融治疗、并完成血糖负荷评估的137例极早期或早期HCC患者。血糖负荷通过糖化血红蛋白（HbA1c）水平进行评估，研究终点为复发和总生存期。采用6.5%单一切点值及6.0%与7.5%双切点值，比较不同血糖负荷水平患者的复发风险和总生存期差异。结果显示，共有51例（37.2%）患者出现HCC复发。以HbA1c≤6.5%为参照，HbA1c>6.5%患者的校正后风险比（aHR）为2.66（95% CI：1.26-5.78）。复发风险随血糖负荷升高呈剂量依赖性增加：6.0
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