Glucagon-like Peptide-1 Receptor Agonists Versus Dipeptidyl Peptidase-4 Inhibitors Following Liver Resection for Hepatocellular Carcinoma in Type 2 Diabetes: Insights from a Target Trial Emulation Study

Highlights

• Postoperative initiation of GLP-1 receptor agonists (GLP-1RAs) after curative-intent liver resection for hepatocellular carcinoma (HCC) in patients with type 2 diabetes (T2D) reduces tumor recurrence risk and improves overall survival compared to dipeptidyl peptidase-4 inhibitors (DPP-4is).
• The largest target trial emulation to date involved 1249 patients from 36 hospitals in China, leveraging real-world electronic medical records for prolonged follow-up (median 50.8 months).
• GLP-1RAs may exert anti-tumor effects beyond glycemic control, suggesting actionable biological mechanisms influencing HCC progression and recurrence.
• Results from the observational emulation warrant prospective clinical trials to establish causality and guide clinical decision-making.

Background