The Relationship of Diabetes and Smoking Status to Hepatocellular Carcinoma Mortality

Abstract

The relationship of diabetes and smoking status to hepatocellular carcinoma (HCC) mortality is not clear. We aimed to investigate the association of smoking cessation relative to diabetes status with subsequent deaths from HCC.We followed up 51,164 participants (aged 44–94 years) without chronic hepatitis B or C from 1 January 1998 to 31 December 2008 enrolled from nationwide health screening units in a prospective cohort study. The primary outcomes were deaths from HCC.During the study period, there were 253 deaths from HCC. History of diabetes was associated with deaths from HCC for both total participants (adjusted hazard ratio [HR], 2.97; 95% confidence interval [CI], 2.08–4.23) and ever smokers with current or past smoking habits (HR, 1.92; 95% CI, 1.10–3.34). Both never smokers (HR, 0.46; 95% CI, 0.32–0.65) and quitters (HR, 0.62; 95% CI, 0.39–0.97) had a lower adjusted risk of HCC deaths compared with current smokers. Among all ever smokers with current or past smoking habits, as compared with diabetic smokers, only quitters without diabetes had a lower adjusted risk of HCC deaths (HR, 0.37; 95% CI, 0.18–0.78). However, quitters with diabetes were observed to have a similar risk of deaths from HCC when compared with smokers with diabetes. Regarding the interaction between diabetes and smoking status on adjusted HCC-related deaths, with the exception of quitters without history of diabetes, all groups had significantly higher HRs than nondiabetic never smokers. There was also a significant multiplicative interaction between diabetes and smoking status on risk of dying from HCC (P = 0.033). We suggest clinicians should promote diabetes prevention and never smoking to associate with reduced subsequent HCC mortality even in adults without chronic viral hepatitis.

Impact of smoking habit on surgical outcomes in non-B non-C patients with curative resection for hepatocellular carcinoma

“…We were able to find 10 studies in the English literature that analyzed the correlation of smoking and HCC mortality[ 33 - 42 ]. Large cohort studies indicating an impact of smoking habit on HCC mortality have been reported form Japan[ 33 , 34 ], the United Kingdom[ 35 ], China[ 36 ] and Taiwan[ 37 - 39 ]. In contrast, several studies reported a negative correlation between HCC mortality and smoking habit, although those studies analyzed relatively small numbers of HCC cases (262-552 cases)[ 40 - 42 ].…”

HbA1c-Based Score Model for Predicting Death Risk in Patients with Hepatocellular Carcinoma and Type 2 Diabetes Mellitus

“…In several models, diabetes is one of the variables [10, 11]. It is also reported that history of diabetes is associated with deaths from HCC [13]. Patients with DM showed significantly lower overall survival than those without DM [14, 15].…”

Are Metabolic Signatures Mediating the Relationship between Lifestyle Factors and Hepatocellular Carcinoma Risk? Results from a Nested Case–Control Study in EPIC

“…The examined predictor variables were restricted to lifestyle factors that have been previously associated with HCC (5)(6)(7)(26)(27)(28)(29)(30)(31)(32)(33) and that were used in the preexisting HLI (18,19). These included BMI (continuous, kg/m 2 ), average lifetime alcohol intake (continuous, g/day), the diet score (continuous), physical activity (continuous, metabolic equivalent of task MET-h/week), smoking (never, ex-smokers quit > 10 years, ex-smokers quit 10 y, current smokers 15 cig/day, current smokers > 15 cig/ day).…”

“…HCC is a multifactorial disease strongly associated with lifestyle factors, most of which are modifiable (5). While hepatitis infection, including both HBV and HCV, remains its primary risk factor, other exposures, such as obesity, alcohol drinking, diabetes, smoking, physical activity, and some dietary items, have also been related to HCC risk (6)(7)(8). Understanding the underlying etiology of HCC is key to help develop disease prevention strategies, including through the identification of metabolic signatures.…”