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Type 2 diabetes mellitus (T2DM) is increasingly known as a risk factor of hepatocellular carcinoma (HCC). In this study, we determined the risk factors associated with HCC in T2DM patients. This was a matched case-control study conducted at two hepatobiliary referral centres in a developing country. Patients’ sociodemographic, clinical, and biochemical characteristics between 1 January 2012 and 30 June 2018 were extracted from the electronic medical records and analysed using multivariate logistic regression analysis. A total of 212 case-control pairs were included. Significant risk factors included Chinese and Malay ethnicities that interacted with viral hepatitis (adjusted odds ratio [AOR] = 11.77, 95% confidence interval [CI]: 1.39–99.79) and (AOR = 37.94, 95% CI: 3.92–367.61) respectively, weight loss (AOR = 5.28, 95% CI: 2.29–12.19), abdominal pain/ discomfort (AOR = 6.73, 95% CI: 3.34–13.34), alcohol (AOR = 4.08, 95% CI: 1.81–9.22), fatty liver (AOR = 3.29, 95% CI: 1.40–7.76), low platelet (AOR = 4.03, 95% CI:1.90–8.55), raised alanine transaminase (AOR = 2.11, 95% CI: 1.16–3.86). and alkaline phosphatase (ALP) levels (AOR = 2.17, 95% CI: 1.17–4.00). Statins reduced the risk of HCC by 63% (AOR = 0.37, 95% CI: 0.21–0.65). The identification of these factors aids the risk stratification for HCC among T2DM patients for early detection and decision-making in patient management in the primary care setting.

Background/aim To determine the survival outcomes and prognostic factors associated with hepatocellular carcinoma (HCC) survival in type 2 diabetes (T2D) patients. Materials and methods This was a retrospective cohort study involving two hepatobiliary centres from January 1, 2012, to June 30, 2018. Medical records were analysed for sociodemographic, clinical characteristics, laboratory testing, and HCC treatment information. Survival outcomes were examined using the Kaplan–Meier and log-rank test. Prognostic factors were determined using multivariate Cox regression. Results A total of 212 patients were included in the study. The median survival time was 22 months. The 1-, 3-, and 5-year survival rates were 64.2%, 34.2%, and 18.0%, respectively. Palliative treatment (adjusted hazard ratio [AHR] = 2.82, 95% confidence interval [CI] 1.75–4.52), tumour size ≥ 5 cm (AHR = 2.02, 95%CI: 1.45–2.82), traditional medication (AHR = 1.94, 95%CI: 1.27–2.98), raised alkaline phosphatase (AHR = 1.74, 95%CI: 1.25–2.42), and metformin (AHR = 1.44, 95%CI: 1.03–2.00) were significantly associated with poor prognosis for HCC survival. Antiviral hepatitis treatment (AHR = 0.54, 95% CI: 0.34–0.87), nonalcoholic fatty liver disease (NAFLD) (AHR = 0.50, 95% CI: 0.30–0.84), and family history of malignancies (AHR = 0.50, 95%CI: 0.26–0.96) were identified as good prognostic factors for HCC survival. Conclusion Traditional medication, metformin treatment, advanced stage and raised alkaline phosphatase were the poor prognostic factors, while antiviral hepatitis treatment, NAFLD, and family history of malignancies were the good prognostic factors for our HCC cases comorbid with T2D.

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