Diabetes Mellitus Is Associated with Hepatocellular Carcinoma: A Retrospective Case-Control Study in Hepatitis Endemic Area

Abstract

BackgroundA number of case-control patient studies have been conducted to investigate the association between diabetes mellitus (DM) and hepatocellular carcinoma (HCC). Despite some controversial reports, it has been suggested that DM is associated with HCC. The previous studies on this subject vary in the selection of populations, sample sizes, methodology, and analysis results. Therefore, it is necessary to further delineate the involvement of DM, together with other related risk factors, in HCC with large sample size and strict analysis methodology.MethodsWe conducted a hospital-based retrospective case-control study at Perking Union Medical College Hospital, China. A total of 1,568 patients with liver diseases were enrolled in the statistical study to evaluate the association of DM and other risk factors with HCC. Among these patients, 716 of them were diagnosed with benign liver diseases, and 852 patients were diagnosed as HCC. We utilized binary logistic regression and stepwise logistic regression to investigate the associations among DM, hypertension, fatty liver, cirrhosis, gallstone, HBV infection, HCV infection, and HCC. ResultsStatistical analysis through the stepwise regression model indicated that the prevalence of DM, male gender, cirrhosis, HCV infection, or HBV infection is higher in the HCC patient group compared to the control group. However, the prevalence of gallstone is negatively associated with HCC cases. DM co-exists with HBV infection, male gender, and age in the HCC cases. Binary logistic regression analysis suggested that DM may synergize with HBV infection in HCC development. ConclusionDM is strongly associated with the increased risk of HCC regardless of the prevalence of HBV infection, HCV infection, cirrhosis, male gender, and age. However, the synergistic interaction between DM and HBV in HCC occurrence is significant. Therefore, DM patients with HBV infection represent a very high HCC risk population and should be considered for HCC close surveillance program.

Diabetes mellitus may affect the long-term survival of hepatitis B virus-related hepatocellular carcinoma patients after liver transplantation

“…Recent studies have shown that DM may be a potential risk factor for HCC[5,7,8], and this hypothesis has been supported by several case control[9-12] and cohort studies[13-17]. Additionally, increased HCC prevalence in the diabetic population has been reported, possibly due to steatohepatitis[7,9].…”

“…The incidence of hepatocellular carcinoma (HCC) in China is dramatically increased by HBV infection, which is the main cause of HCC[3,4]. Over 70% of cases of HCC in China have been associated with HBV infection[5]. …”

The Influence of Metabolic Syndrome on the Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B Infection in Mainland China

“…Viral infection in HCC cases was commonly observed to be copresent with other etiologic factors of this malignancy (6)(7)(8). It has been reported that in areas with a high prevalence of hepatitis viral infections, 8.4% to 24.1% of HBV/HCV-related HCC cases presented with type 2 diabetes (7, 9-12), 19.6% to 41.7% with hypertension (11,12), 5.4% to 23.4% with alcohol abuse (13), and 28.3% to 33.0% with smoking habits (4,13). Previous studies have demonstrated synergistic effects between HCV infections and alcohol consumption (2), obesity and diabetes (7,14).…”

The association of hepatitis C virus infection and post‐liver transplant diabetes: data from 17 000 HCV‐infected transplant recipients

“…In the past, a number of studies have shown that HCV promotes IR through viral‐associated mechanisms as well as activation of various inflammatory processes . The evidence for this association comes from a number of different sources including studies from tertiary care centres, population‐based studies, basic science research and therapeutic clinical trials of HCV . The association is strongest for HCV genotype 3 but remains important for all HCV genotypes.…”

“…Over the past decades, a number of reports from both cohort and population‐based studies have suggested an association between hepatitis C virus (HCV) infection and insulin resistance (IR) and type 2 diabetes (DM) . HCV‐induced diabetes mellitus is currently believed to be a result of insulin resistance in both hepatic and peripheral tissue.…”